Shortell Stephen M
University of California, Berkeley, USA.
Med Care Res Rev. 2004 Sep;61(3 Suppl):12S-30S. doi: 10.1177/1077558704266768.
There is growing consensus that the U.S. health care system is not producing value relative to the resources invested. Unwarranted variation exists in quality and outcomes of care and underutilization of both evidence-based medicine and evidence-management practices. To address these issues, this article calls for a broad-based social science approach focused on obtaining a greater understanding of change at the individual, group, organizational, and environmental levels as they influence each other. Specific examples and questions for research are suggested with regard to the redesign of care systems, enhancing learning and transferring knowledge, and creating effective financial incentives. The specific measurement, analysis, and study design issues involved in under-taking such a research agenda are discussed.
越来越多的人达成共识，即美国医疗保健系统相对于投入的资源而言并未产生价值。医疗服务的质量和结果存在不必要的差异，循证医学和循证管理实践的利用不足。为了解决这些问题，本文呼吁采用一种基础广泛的社会科学方法，重点是更深入地理解个体、群体、组织和环境层面的变化及其相互影响。针对护理系统的重新设计、加强学习和知识转移以及创造有效的经济激励措施，提出了具体的例子和研究问题。讨论了开展这样一个研究议程所涉及的具体测量、分析和研究设计问题。
