Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Am J Perinatol. 2012 Jan;29(1):35-42. doi: 10.1055/s-0031-1285826. Epub 2011 Aug 4.
Despite an increased focus on the quality and safety of care, the United States health care system does not reliably deliver safe, high-quality care for all women and infants. In many cases, a gap still exists between best evidence and routine practice and pregnant women and neonates continue to experience preventable harm. Effective change strategies targeting individuals, groups or teams, organizations, and the larger system or environment have been used in the setting of perinatal care to improve quality and safety. In addition, strategies focused on aligning change efforts across multiple levels are increasingly being used to more effectively change practice in the context of the complex health care system. This review examines some of the single-level and multilevel approaches to changing practice that have been used in perinatal safety and quality improvement. Although progress has been slow, improvements in quality and safety measurement, widespread commitment to implementing effective practice change interventions, and advances in perinatal improvement and implementation research will help ensure that the dramatic improvements in perinatal quality and safety that have been anticipated will truly be realized.
尽管美国医疗保健系统越来越关注护理质量和安全性，但仍不能为所有妇女和婴儿提供安全、高质量的护理。在许多情况下，最佳证据与常规实践之间仍然存在差距，孕妇和新生儿仍会遭受可预防的伤害。在围产期护理中，已经使用了针对个人、群体或团队、组织以及更大的系统或环境的有效变革策略来提高质量和安全性。此外，越来越多地使用侧重于跨多个层次协调变革工作的策略，以在复杂的医疗保健系统背景下更有效地改变实践。本文回顾了一些用于围产期安全和质量改进的单层次和多层次实践变革方法。尽管进展缓慢，但在质量和安全性测量方面的改进、广泛致力于实施有效的实践变革干预措施，以及围产期改进和实施研究方面的进展，将有助于确保预期的围产期质量和安全性的显著提高真正得以实现。
