数量高于质量：质量衡量标准的提高如何并未产生高质量的结果。
Quantity Over Quality: How the Rise in Quality Measures is Not Producing Quality Results.
作者信息
Esposito Michele L, Selker Harry P, Salem Deeb N
机构信息
Department of Medicine, Tufts Medical Center, Boston, MA, USA.
出版信息
J Gen Intern Med. 2015 Aug;30(8):1204-7. doi: 10.1007/s11606-015-3278-6. Epub 2015 Mar 24.
Abstract
Over the past decade, quality measures (QMs) have been implemented nationally in order to establish standards aimed at improving the quality of care. With the expansion of their role in the Affordable Care Act and pay-for-performance, QMs have had an increasingly significant impact on clinical practice. However, adverse patient outcomes have resulted from adherence to some previously promulgated performance measures. Several of these QMs with unintended consequences, including the initiation of perioperative beta-blockers in noncardiac surgery and intensive insulin therapy for critically ill patients, were instituted as QMs years before large randomized trials ultimately refuted their use. The future of quality care should emphasize the importance of evidence-based, peer-reviewed measures.
摘要
在过去十年中，质量指标（QMs）已在全国范围内实施，以建立旨在提高医疗质量的标准。随着其在《平价医疗法案》和按绩效付费中的作用不断扩大，质量指标对临床实践产生了越来越重大的影响。然而，坚持一些先前颁布的绩效指标导致了不良的患者结局。其中一些质量指标产生了意想不到的后果，包括在非心脏手术中使用围手术期β受体阻滞剂以及对重症患者进行强化胰岛素治疗，这些指标在多年前作为质量指标实施，而大型随机试验最终驳斥了它们的使用。优质护理的未来应强调循证、同行评审指标的重要性。
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