Kaye Erica C, Abramson Zachary R, Snaman Jennifer M, Friebert Sarah E, Baker Justin N
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Department of Radiology, Baptist Hospital, Memphis, Tennessee, USA.
J Pain Symptom Manage. 2017 May;53(5):952-961. doi: 10.1016/j.jpainsymman.2016.12.326. Epub 2017 Jan 3.
Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable.
To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC.
PubMed and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity.
Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed.
Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value.
医疗保健领域对劳动力生产率的定义尚不明确。特别是在儿科姑息治疗（PPC）领域，缺乏共识性指标阻碍了对数据的汇总和分析，从而难以追踪劳动力效率和效果。缺乏统一衡量的数据也不利于制定提高生产率的创新策略，阻碍了对生产率与护理质量之间关系的研究，而这两者相互关联但不可相互替代。
回顾有关PPC中生产率定义和测量的文献；确定传统PPC模式下生产率的障碍；并推荐新的指标来研究生产率，将其作为PPC中优质护理的一个组成部分。
使用关键词（儿科姑息治疗、姑息治疗、团队、劳动力、工作流程、生产率、算法、优质护理、质量改进、质量指标、住院患者、医院、会诊、模式）在PubMed和Cochrane系统评价数据库中搜索2000年至2016年发表的学术文献。还对推进姑息治疗中心、全国临终关怀与姑息治疗组织、全国家庭护理与临终关怀协会、美国临终关怀与姑息医学学会、临终关怀与姑息护理护士协会、国家质量论坛和国家姑息治疗质量共识项目进行了机构搜索。另外，对美国七个著名PPC项目的主任进行了半结构化访谈，以审查PPC团队工作流程和生产率的标准操作程序。
在PPC领域，对于定义、测量和分析提供者及项目生产率的最佳方法，几乎没有达成共识。准确监测生产率的障碍包括难以识别、测量和解释适用于跨学科护理模式的指标。鉴于传统会诊模式固有的低效情况，提出了新的生产率指标。
需要进一步研究以确定监测PPC团队生产率的最佳指标。应研究创新方法，目标是在不损害价值的情况下提高护理效率。
