Crema Maria, Verbano Chiara
Department of Management and Engineering, University of Padova, Stradella San Nicola, 3, 36100 Vicenza, Italy.
Int J Qual Health Care. 2017 Nov 1;29(7):889-895. doi: 10.1093/intqhc/mzx135.
Choosing Wisely (CW) is an emergent approach to identify and reduce unnecessary care, such as tests and treatments that do not add value for patients and may even cause harm. The purpose of this paper is to investigate whether and how Lean Healthcare Management (LHM) can support CW objectives, focusing on customer needs and on waste elimination.
A systematic literature review has been performed in Scopus, PubMed and Web of Science.
Peer reviewed articles published in English language have been selected. Papers were considered if they regarded LHM and its possible support for achieving CW objectives. Data extraction. The links between the LHM purposes of adoption and the pursued CW objectives were investigated. Moreover, LHM tools, practices and interventions to support CW were grasped.
Sixteen articles were included in the analysis. Links between the identified LHM purposes of adoption and CW objectives were discovered: through process understanding, optimization, evaluation and control, LHM contributes to the reduction of overuses in healthcare, but also to the delivery of a more effective and evidence-based care (EBC). Moreover, it provides an objective approach useful for choosing the most cost-effective solution among different alternatives.
Results highlight how LHM, and with which tools and practices, can be adopted to enhance the healthcare appropriateness pursued by CW, paving the way for interesting future research about this emerging topic.
明智选择（CW）是一种新兴方法，用于识别和减少不必要的医疗护理，例如对患者没有附加价值甚至可能造成伤害的检查和治疗。本文的目的是研究精益医疗管理（LHM）是否以及如何能够支持CW目标，重点关注客户需求和消除浪费。
在Scopus、PubMed和科学网进行了系统的文献综述。
选取了以英文发表的同行评审文章。如果文章涉及LHM及其对实现CW目标的可能支持，则予以考虑。数据提取。研究了采用LHM的目的与所追求的CW目标之间的联系。此外，还掌握了支持CW的LHM工具、实践和干预措施。
16篇文章纳入分析。发现了已确定的采用LHM的目的与CW目标之间的联系：通过流程理解、优化、评估和控制，LHM有助于减少医疗保健中的过度使用，也有助于提供更有效和基于证据的护理（EBC）。此外，它提供了一种客观方法，有助于在不同备选方案中选择最具成本效益的解决方案。
结果突出了如何采用LHM以及采用哪些工具和实践来提高CW所追求的医疗保健适宜性，为关于这一新兴主题的有趣未来研究铺平了道路。
