Callcut Rachael A, Breslin Tara M
Department of Surgery, University of Wisconsin-Madison, USA.
Ann Surg. 2006 Mar;243(3):304-12. doi: 10.1097/01.sla.0000200854.34298.e3.
To educate surgeons about the growth of the private regulatory movement and its potential implications for the practice of surgery.
An in-depth analysis and literature review of one of the largest private regulatory groups, the Leapfrog Group, provides a model for understanding the impact of these groups on the practice of surgery. A detailed discussion of the history, mission, structure, and quality initiatives of Leapfrog is included.
Private regulatory groups are using quality standards as a method for controlling the rising cost of health care. Traditionally, little financial support, manpower, or incentives have existed for individual surgeons and hospitals to report and maintain their own outcomes data. However, as surgical outcomes have increasingly become the target of quality improvement initiatives, the need to measure performance is gaining importance. Surgical quality has been both a direct target of private regulation, as illustrated by the evidence-based hospital referral guidelines of Leapfrog, and an indirect target with initiatives like computerized physician order entry and ICU staffing guidelines.
Private regulation is rapidly reshaping the way we practice and teach surgery. It is almost a certainty that their power, popularity, financial support, and missions will all continue to expand. As surgeons, we must decide soon if we wish to be an active participant in shaping the movement or, rather, if we are going to let it shape us by remaining largely uninvolved.
让外科医生了解私营监管运动的发展及其对外科手术实践的潜在影响。
对最大的私营监管组织之一“跨越组织”进行深入分析和文献综述，为理解这些组织对外科手术实践的影响提供了一个模型。其中包括对“跨越组织”的历史、使命、结构和质量倡议的详细讨论。
私营监管组织将质量标准作为控制医疗保健成本上升的一种方法。传统上，对于个体外科医生和医院来说，几乎没有财政支持、人力或激励措施来报告和维护他们自己的结果数据。然而，随着手术结果越来越成为质量改进倡议的目标，衡量绩效的需求变得越来越重要。手术质量既是私营监管的直接目标，如“跨越组织”基于证据的医院转诊指南所示，也是计算机化医嘱录入和重症监护病房人员配备指南等倡议的间接目标。
私营监管正在迅速重塑我们实施外科手术和教授外科手术的方式。几乎可以肯定的是，它们的权力、知名度、财政支持和使命都将继续扩大。作为外科医生，我们必须尽快决定是希望积极参与塑造这一运动，还是宁愿在很大程度上不参与，任由它塑造我们。
