Swan Beth Ann, Boruch Robert F
Office of International Programs & PAHO/WHO Collaborating Center for Nursing and Midwifery Leadership, and the Family and Community Health Division, University of Pennsylvania School of Nursing, Philadelphia, USA.
Med Care. 2004 Feb;42(2 Suppl):II12-20. doi: 10.1097/01.mlr.0000109123.10875.5c.
In 1998, the Committee on Health Care Quality in America was created and given the charge of devising a strategy to achieve substantial improvement in the quality of health care for all Americans. One strategy to move the quality agenda forward is the use of evidence by both providers of health care and consumers of health care. One feature of this agenda, evidence-based practice, refers to a hierarchy of evidence ranging from individual randomized, controlled trials to expert opinion.
The purposes of this article are to describe the evidence base in nursing, discuss the quality and strength of nursing's evidence, illustrate the application of the Quality Health Outcomes Model, and present recommendations for practice, research, and policy to increase nursing's contribution to quality health care.
Nurses everywhere must use innovative solutions to operationalize the "evidence" in evidence-based nursing. The Quality Health Outcomes Model (QHOM) provides a useful way of advancing research and evidence about the quality of health care in America. In concert with the conceptual framework for the National Health Care Quality Report, the QHOM provides a map for identifying evidence gaps and research questions arising from the model and conceptual framework, as well as evidence synthesis (integrating methodologic quality) driven by theoretical understanding.
1998年，美国医疗保健质量委员会成立，并负责制定一项战略，以大幅提高所有美国人的医疗保健质量。推动质量议程向前发展的一项战略是医疗保健提供者和消费者都使用证据。该议程的一个特点，即循证实践，指的是从个体随机对照试验到专家意见的一系列证据等级。
本文的目的是描述护理领域的证据基础，讨论护理证据的质量和强度，说明质量健康结果模型的应用，并提出关于实践、研究和政策的建议，以增加护理对优质医疗保健的贡献。
各地护士必须采用创新解决方案，将循证护理中的“证据”付诸实践。质量健康结果模型（QHOM）为推进有关美国医疗保健质量的研究和证据提供了一种有用的方式。与《国家医疗保健质量报告》的概念框架相一致，QHOM提供了一张地图，用于识别该模型和概念框架中产生的证据差距和研究问题，以及由理论理解驱动的证据综合（整合方法学质量）。
