Hilarion Pilar, Suñol Rosa, Groene Oliver, Vallejo Paula, Herrera Elisabeth, Saura Rosa Maria
Avedis Donabedian Research Institute, Autonomous University of Barcelona, Spain.
Health Policy. 2009 Apr;90(1):94-103. doi: 10.1016/j.healthpol.2008.08.002. Epub 2008 Oct 1.
To describe a methodology and the results of projects combining consensus processes for indicator development with methods of external assessment of health and social services.
Our methodology can be characterized by a four-step approach: (1) stakeholder involvement and creating an enabling environment, (2) using standardized consensus methods for indicator development, (3) using rigorous external evaluation methods to assess results and (4) developing and implementing quality improvement initiatives. We describe each step in detail and discuss factors of success and pitfalls based on our experience of applying the methodology in 648 health/social centres and reviewing overall 68,616 case records.
We observe in four sectors (assisted living, elderly health care, care for people with drug abuse problems, and care for abused woman) improvements in overall quality improvement rates, ranging from 9.5% to 65.6%. Improvements in overall rates are accompanied by reduction in range of up to 48.8.
The conscientious setting up of an enabling environment and the systematic involvement of professionals in designing indicators and setting standards is a key to improving performance. Our research may entail lessons for policy makers on the current debate on pay for performance models.
描述一种将指标制定的共识过程与卫生和社会服务外部评估方法相结合的项目方法及结果。
我们的方法可通过四步流程来描述：（1）利益相关者参与并营造有利环境；（2）使用标准化共识方法制定指标；（3）使用严格的外部评估方法评估结果；（4）制定并实施质量改进举措。我们详细描述了每一步，并根据我们在648个卫生/社会中心应用该方法的经验以及审查的68,616份病例记录，讨论了成功因素和陷阱。
我们观察到在四个领域（辅助生活、老年保健、药物滥用问题人群护理以及受虐妇女护理）总体质量改进率有所提高，范围从9.5%到65.6%。总体率的提高伴随着范围缩小，降幅高达48.8。
认真营造有利环境并让专业人员系统参与指标设计和标准制定是提高绩效的关键。我们的研究可能会为政策制定者当前关于绩效薪酬模式的辩论提供经验教训。
