Neil Nancy, Nerenz David
Virginia Mason Medical Center, Seattle, USA.
Jt Comm J Qual Saf. 2003 Oct;29(10):531-8. doi: 10.1016/s1549-3741(03)29063-8.
The ability to use available administrative and clinical information to produce performance reports is a key element of quality improvement. Six health care systems were identified that have done a particularly effective or innovative job of creating and implementing performance measurement tools and systems by using data available in existing clinical and administrative information systems: Dean Health System (Madison, WI), Sharp HealthCare (San Diego), Henry Ford Health System (Detroit), Scripps Health (San Diego), Legacy Health System (Portland, OR), and Lovelace Health System (Albuquerque).
Interest in comparative performance information for health care organizations remains strong. The perfect measure set has not yet been invented. Every measure has one or more flaws, as do the data systems available to support them. Managers may take comfort, however, in the knowledge that performance measures need not be perfect to be useful. Measures tend to improve when people use the data to inform decisions that matter. Even the most accurate data, though, are not useful if there is either too much or too little "organizational distance" between the unit of analysis for the data and the unit of control for making change. Some systems have adopted a layered approach to performance measurement, in which measures are aggregated for reporting and use at the level of major operating units or divisions and then disaggregated for reporting and use at smaller levels and eventually to the level of individual clinicians.
利用现有的管理和临床信息生成绩效报告的能力是质量改进的关键要素。现已确定六个医疗保健系统，它们在通过使用现有临床和管理信息系统中的数据来创建和实施绩效衡量工具及系统方面，工作尤为有效或具有创新性：迪安医疗系统（威斯康星州麦迪逊）、夏普医疗保健公司（圣地亚哥）、亨利·福特医疗系统（底特律）、斯克里普斯健康公司（圣地亚哥）、遗产健康系统（俄勒冈州波特兰）以及洛夫莱斯健康系统（新墨西哥州阿尔伯克基）。
对医疗保健组织的比较绩效信息的兴趣依然浓厚。尚未发明出完美的衡量标准集。每项衡量标准都存在一个或多个缺陷，支持这些标准的数据系统亦是如此。然而，管理人员可能会感到欣慰的是，他们知道绩效衡量标准不必完美才有用。当人们利用数据为重要决策提供信息时，衡量标准往往会得到改进。不过，即便数据最为准确，但如果数据的分析单位与进行变革的控制单位之间存在“组织距离”过大或过小的情况，这些数据也毫无用处。一些系统采用了分层的绩效衡量方法，即先将衡量标准汇总，以便在主要运营单位或部门层面进行报告和使用，然后再细分，以便在较小层面乃至个体临床医生层面进行报告和使用。
