Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, NY.
Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, NY.
Chest. 2013 Jun;143(6):1542-1547. doi: 10.1378/chest.12-2491.
Linking health-care quality improvement to payment appears straightforward. Improve the care that one provides to one's patients, and one is rewarded financially. Should one fail to improve care, then one is financially penalized. However, this strategy assumes that health-care workers and administrators possess the necessary tools and knowledge to improve care and that the metrics being measured have been rigorously tested. Although health-care workers and hospitals are publically committed to reducing inappropriate care, improving patient safety, achieving better health outcomes, and holding down costs, many are unsure how to do this effectively. We present the case that it is not usually the people who create the problems in our health system; rather, it is the processes of the care-delivery system that require change. Incentivizing performance improvement using simple metrics is unlikely to work before using compensation strategies to incentivize behavior change in clinical systems. But prior to even doing this, leaders and physicians must first create accurate performance measures and understand improvement science.
将医疗质量改进与支付联系起来似乎很简单。提高对患者的护理水平，就会获得经济奖励。如果未能改善护理，就会受到经济处罚。然而，这种策略假设医疗保健工作者和管理人员具备必要的工具和知识来改善护理，并且所衡量的指标已经经过严格测试。尽管医疗保健工作者和医院公开承诺减少不当护理、提高患者安全性、实现更好的健康结果和控制成本，但许多人不确定如何有效地做到这一点。我们提出的观点是，造成我们医疗体系问题的通常不是人，而是医疗服务系统的流程需要改变。在使用补偿策略激励临床系统的行为改变之前，使用简单的指标来激励绩效改进不太可能奏效。但在此之前，领导者和医生必须首先创建准确的绩效衡量标准，并了解改进科学。
