Loebe M, Tewani S, Bruckner B A, Disbot M
Division of Transplant and Assist Devices, Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA.
Dtsch Med Wochenschr. 2009 Oct;134 Suppl 6:S234-6. doi: 10.1055/s-0029-1241921. Epub 2009 Oct 15.
Quality control and performance improvement in the US health care system are based on several pillars: external review is performed by either government agencies, insurance companies, or public media. In cardiac surgery the STS database forms the backbone of most of these reviews. Internal review is based on providing outcome data, establishing benchmarks for performance, and root-cause analysis of adverse events. Peer review is used to analyze major issues in providing care. Transparency of the process and of outcome numbers generated is key for the success of measurements to improve performance. Finally, education of all health care providers in the hospital is needed to provide quality care and good outcomes. Maintaining proficiency of physicians and hospital personal in pathways and procedures requires constant educational efforts and clear pathways and guidelines. Growing resources have to be dedicated to quality management. As outcome data become essential in obtaining insurance contracts and government certification the investing into a comprehensive quality assurance program will pay off.
外部审查由政府机构、保险公司或公共媒体进行。在心脏手术中，胸外科医师协会（STS）数据库构成了大多数此类审查的基础。内部审查基于提供结果数据、确立绩效基准以及对不良事件进行根本原因分析。同行评审用于分析提供护理过程中的重大问题。过程和所产生结果数据的透明度是提高绩效的衡量标准取得成功的关键。最后，需要对医院的所有医疗保健提供者进行教育，以提供高质量的护理和良好的结果。要保持医生和医院工作人员在诊疗流程和程序方面的专业水平，需要持续的教育努力以及清晰的流程和指南。必须投入越来越多的资源用于质量管理。由于结果数据在获得保险合同和政府认证方面变得至关重要，投资于全面的质量保证计划将会有回报。
