Department of Urology, University of Michigan, Ann Arbor, Michigan.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
Curr Opin Urol. 2018 Jul;28(4):348-353. doi: 10.1097/MOU.0000000000000514.
Physician-led quality improvement collaboratives have emerged across surgical disciplines as a means to measure and subsequently improve the quality and cost of care. In this review, we will provide an overview of recent successes within quality improvement collaboratives, as well as discuss future opportunities for such initiatives.
Successful quality improvement collaboratives have coupled data registries with a collegial environment to achieve data-driven improvements in care across diverse practice settings. Such efforts have a track record for accomplishing specific patient safety gains, and have more recently addressed complex care scenarios where data and consensus building have been leveraged to clarify optimal care pathways. Collaboratives are currently exploring mechanisms to meaningfully impact increasingly complex elements of care delivery, such as individual surgeon performance.
Quality improvement collaboratives are in a unique position to understand patterns in care across populations, lead evidence-based assessments of variation in quality, and to attempt to intervene to improve outcomes based on the data they accumulate. As healthcare increasingly shifts to emphasize quality of care, physician-led collaboratives represent an important mechanism to drive improvement.
以医生为主导的质量改进合作已经在外科各学科中出现，成为衡量和随后改善医疗质量和成本的一种手段。在这篇综述中，我们将概述质量改进合作中的最新成功案例，并讨论此类举措的未来机会。
成功的质量改进合作将数据登记与同事关系相结合，在不同的实践环境中实现了以数据为导向的护理改善。这些努力在实现特定的患者安全收益方面有良好的记录，最近又针对复杂的护理情况采取了行动，利用数据和共识的建立来澄清最佳的护理路径。合作组织目前正在探索有效的机制，以对日益复杂的医疗服务交付元素（如个别外科医生的绩效）产生有意义的影响。
质量改进合作组织具有独特的优势，可以了解人群中的护理模式，对质量差异进行基于证据的评估，并根据他们积累的数据尝试进行干预以改善结果。随着医疗保健越来越强调医疗质量，以医生为主导的合作组织代表了推动改进的一个重要机制。
