Arch Intern Med. 2011 Aug 8;171(15):1385-90. doi: 10.1001/archinternmed.2011.231. Epub 2011 May 23.
Physicians can adhere to the principles of professionalism by practicing high-quality, evidence-based care and advocating for just and cost-effective distribution of finite clinical resources. To promote these principles, the National Physicians Alliance (NPA) initiated a project titled "Promoting Good Stewardship in Clinical Practice" that aimed to develop a list of the top 5 activities in family medicine, internal medicine, and pediatrics where the quality of care could be improved.
Working groups of NPA members in each of the 3 primary care specialties agreed that an ideal activity would be one that was common in primary care practice, that was strongly supported by the evidence, and that would lead to significant health benefits and reduce risks, harms, and costs. A modification of nominal group process was used to generate a preliminary list of activities. A first round of field testing was conducted with 83 primary care physicians, and a second round of field testing with an additional 172 physicians.
The first round of field testing resulted in 1 activity being deleted from the family medicine list. Support for the remaining activities was strong. The second round of field testing showed strong support for all activities. The family medicine and internal medicine groups independently selected 3 activities that were the same, so the final lists reflect 12 unique activities that could improve clinical care.
Physician panels in the primary care specialties of family medicine, internal medicine, and pediatrics identified common clinical activities that could lead to higher quality care and better use of finite clinical resources. Field testing showed support among physicians for the evidence supporting the activities, the potential positive impact on medical care quality and cost, and the ease with which the activities could be performed. We recommend that these "Top 5" lists of activities be implemented in primary care practice across the United States.
医生可以通过提供高质量的循证医疗服务，并倡导公正且具有成本效益地分配有限的临床资源，来坚守专业精神原则。为了推广这些原则，美国国家医师联盟（NPA）发起了一个名为“促进临床实践中的良好管理”的项目，该项目旨在制定一份家庭医学、内科医学和儿科学领域中可改善医疗质量的五大活动清单。
NPA成员在这3个初级保健专业领域分别成立了工作组，他们一致认为理想的活动应具备以下特点：在初级保健实践中常见、有充分的证据支持、能带来显著的健康益处并降低风险、危害和成本。采用名义小组法的一种改进形式来生成活动的初步清单。第一轮现场测试对83名初级保健医生进行，第二轮现场测试又增加了172名医生。
第一轮现场测试导致家庭医学清单中有1项活动被删除。对其余活动的支持力度很大。第二轮现场测试表明对所有活动都有很强的支持。家庭医学组和内科医学组独立选出了3项相同的活动，因此最终清单列出了12项可改善临床护理的独特活动。
家庭医学、内科医学和儿科学等初级保健专业领域的医生小组确定了一些常见的临床活动，这些活动可带来更高质量的医疗服务，并更好地利用有限的临床资源。现场测试表明医生们支持这些活动的证据、它们对医疗质量和成本的潜在积极影响，以及这些活动的可操作性。我们建议在美国各地的初级保健实践中实施这些“五大”活动清单。
