Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Clin Gastroenterol Hepatol. 2013 Aug;11(8):908-12. doi: 10.1016/j.cgh.2013.05.027. Epub 2013 Jun 5.
The term quality of care has been interpreted in different ways in medicine. Skeptics of the quality movement insist that checkboxes and government and payer oversight will not lead to better patient outcomes. Supporters refer to areas in medicine in which quality improvement efforts have led to improved survival, such as in cystic fibrosis and cardiovascular disease. For quality improvement to be effective, the process demands rigorous documentation, analysis, feedback, and behavioral change. This requires valid metrics and mechanisms to provide dynamic point-of-care (or close to point of care) feedback in a manner that drives improvement. For inflammatory bowel disease, work has been performed in Europe and the United States to develop a framework for how practitioners can improve quality of care. Improve Care Now has created a sophisticated quality improvement program for pediatric patients with inflammatory bowel disease. The American Gastroenterology Association has worked within the National Quality Strategy framework to develop quality measures for patients with inflammatory bowel disease that have been incorporated into Federal programs that are moving Medicare reimbursement from a volume-based to a value-based structure. The Crohn's and Colitis Foundation of America is initiating a quality intervention program that can be implemented in community and academic practices to stimulate continual improvement processes for patients with inflammatory bowel disease. All of this work is intended to make quality improvement programs both feasible and useful, with the ultimate goal of improving quality of life for our patients.
在医学中，“护理质量”一词有不同的解释。对质量运动持怀疑态度的人坚持认为，复选框和政府及付款人监督不会带来更好的患者结果。支持者则提到了医学中一些通过质量改进措施提高生存率的领域，如囊性纤维化和心血管疾病。为了使质量改进有效，该过程需要严格的文件记录、分析、反馈和行为改变。这需要有效的指标和机制，以便以促进改进的方式提供动态即时（或接近即时）的反馈。对于炎症性肠病，已经在欧洲和美国开展了工作，以制定从业者如何提高护理质量的框架。“现在改善护理”为患有炎症性肠病的儿科患者创建了一个复杂的质量改进计划。美国胃肠病学协会在国家质量战略框架内制定了针对炎症性肠病患者的质量指标，这些指标已纳入联邦计划，将医疗保险的报销从基于数量转变为基于价值的结构。美国克罗恩病和结肠炎基金会正在启动一个质量干预计划，可以在社区和学术实践中实施，以刺激炎症性肠病患者的持续改进过程。所有这些工作都是为了使质量改进计划既可行又有用，最终目标是提高我们患者的生活质量。
