Gardner Karina, Mazza Danielle
Department of General Practice, School of Primary Health Care, Monash University, Victoria.
Aust Fam Physician. 2012 Mar;41(3):151-4.
In 2010, the federal government introduced the first comprehensive national policy statement for primary healthcare in Australia. This policy identifies key reform initiatives with the overall aim of improving the quality of healthcare. However, what constitutes quality and how to measure it is the subject of ongoing debate both nationally and internationally.
In this article we explore the current experience of defining quality and implementing quality frameworks in general practice settings in New Zealand, the United Kingdom, Germany and Australia.
There are multiple and varying definitions of quality in general practice, but most emphasise patient experience as their primary focus. The quality frameworks used in the countries investigated are all based on Donabedian's systems-based framework of structure, process and outcome. Implementation and application varies however, with top-down approaches in New Zealand and the United Kingdom, and bottom-up approaches in Germany. Provision of high quality care is the primary goal in all the systems described. External standards, targets and incentives are important initiatives, but countries with high quality general practice excel at empowering general practice to own the quality agenda.
2010年，澳大利亚联邦政府出台了首份关于初级医疗保健的全面国家政策声明。该政策确定了关键改革举措，总体目标是提高医疗保健质量。然而，何为质量以及如何衡量质量，在国内和国际上仍是持续争论的话题。
在本文中，我们探讨了新西兰、英国、德国和澳大利亚在普通医疗环境中定义质量和实施质量框架的当前经验。
普通医疗中质量的定义多种多样且各不相同，但大多数都强调将患者体验作为主要关注点。所调查国家使用的质量框架均基于唐纳贝迪安基于系统的结构、过程和结果框架。然而，实施和应用情况各不相同，新西兰和英国采用自上而下的方法，德国采用自下而上的方法。在所描述的所有系统中，提供高质量护理都是主要目标。外部标准、目标和激励措施是重要举措，但拥有高质量普通医疗服务的国家在赋予普通医疗服务机构自主制定质量议程的权力方面表现出色。
