Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada.
Centre for Quality Improvement and Patient Safety and the Department of Medicine, University of Toronto, Toronto, Canada.
J Eval Clin Pract. 2019 Jun;25(3):363-368. doi: 10.1111/jep.13135. Epub 2019 Apr 11.
Quality improvement (QI) as a clinical improvement science has been criticized for failing to deliver broad patient outcome improvement and for being a top-down regulatory and compliance construct. These critics have argued that the focus of QI should be on increasing adherence to clinical practice guidelines (CPGs) and, as a result, should be consolidated into research structures with the science of evidence-based medicine (EBM) at the helm. We argue that EBM often overestimates the role of knowledge as the root cause of quality problems and focuses almost exclusively on the effectiveness of care while often neglecting the domains of safety, efficiency, patient-centredness, and equity. Successfully addressing quality problems requires a much broader, systems-based view of health-care delivery. Although essential to clinical decision-making and practice, EBM cannot act as the cornerstone of health system improvement.
质量改进（QI）作为一门临床改进科学，一直受到批评，因为它未能带来广泛的患者结果改善，并且是一种自上而下的监管和合规结构。这些批评者认为，QI 的重点应该是提高对临床实践指南（CPG）的依从性，因此，应该将其纳入以循证医学（EBM）科学为指导的研究结构中。我们认为，EBM 经常高估知识作为质量问题根源的作用，并且几乎只关注护理的有效性，同时经常忽略安全、效率、以患者为中心和公平性等领域。成功解决质量问题需要对医疗保健提供有更广泛、基于系统的观点。尽管 EBM 对临床决策和实践至关重要，但它不能作为卫生系统改进的基石。
