Oregon Health & Science University, Portland, Oregon, USA; Instituto Nacional de Salud Publica, Centro de Investigacion en Salud Poblacional, Cuernavaca, Mexico; OHSU-PSU School of Public Health, Health Systems Management & Policy, Portland, Oregon, USA.
Ipas, Chapel Hill, NC, USA.
Contraception. 2019 Nov;100(5):354-359. doi: 10.1016/j.contraception.2019.07.006. Epub 2019 Jul 26.
Little consensus exists about how to measure quality of care in abortion. Our purpose is to (a) provide common language for healthcare quality definitions, frameworks and measurement; (b) synthesize literature about quality measurement in abortion; and (c) present criteria for quality metric development. Quality includes effectiveness, patient centeredness, timeliness, efficiency and equity of care. Information about structure, process and outcomes of care is used to measure quality. We do not have good evidence about expected population-level health and behavioral outcomes associated with improving abortion service quality. Abortion patients overwhelmingly report high satisfaction with services, but it is not clear if their satisfaction indicates high-quality care. Guidance exists for quality metric selection; measures must focus on priority topics, be scientifically sound and be feasible. Technical quality standards and clinical guidelines exist, but we lack a standard set of quality metrics. Partners in the Abortion Service Quality Initiative (https://asq-initiative.org/) are collaborating to develop the first-ever global standard for measuring abortion service quality in low- and middle-income countries, both in and out of health care facilities. Standardized and validated quality metrics would move our field forward and contribute to quality improvement activities and, ultimately, to improved health outcomes for women and families. IMPLICATIONS: We define quality of health care, synthesize the evidence about quality of care in abortion and advocate for standardized and validated quality metrics to improve health outcomes for women.
关于如何衡量堕胎护理质量，目前尚未达成共识。我们的目的是：(a) 为医疗保健质量定义、框架和衡量标准提供通用语言；(b) 综合有关堕胎质量衡量的文献；(c) 提出质量指标制定标准。质量包括护理的有效性、以患者为中心、及时性、效率和公平性。用于衡量质量的信息包括护理的结构、过程和结果。我们没有关于改善堕胎服务质量与预期人群健康和行为结果相关的良好证据。堕胎患者对服务的满意度极高，但尚不清楚他们的满意度是否表明护理质量高。质量指标选择有指导意见；措施必须关注重点议题，具有科学合理性且切实可行。存在技术质量标准和临床指南，但我们缺乏一套标准的质量指标。堕胎服务质量倡议（https://asq-initiative.org/）的合作伙伴正在合作制定首个衡量中低收入国家堕胎服务质量的全球标准，包括医疗保健机构内外的服务质量标准。标准化和验证后的质量指标将推动我们的领域向前发展，并有助于质量改进活动，最终改善妇女和家庭的健康结果。意义：我们定义了医疗保健质量，综合了有关堕胎护理质量的证据，并倡导使用标准化和验证后的质量指标，以改善妇女的健康结果。
