MacGillivray Thomas E
HOUSTON METHODIST DEBAKEY HEART AND VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.
Methodist Debakey Cardiovasc J. 2020 Jul-Sep;16(3):192-198. doi: 10.14797/mdcj-16-3-192.
The American health care system has many great successes, but there continue to be opportunities for improving quality, access, and cost. The fee-for-service health care paradigm is shifting toward value-based care and will require accountability around quality assurance and cost reduction. As a result, many health care entities are rallying health care providers, administrators, regulators, and patients around a national imperative to create a culture of safety and develop systems of care to improve health care quality. However, the culture of patient safety and quality requires rigorous assessment of outcomes, and while numerous data collection and decision support tools are available to assist in quality assessment and performance improvement, the public reporting of this data can be confusing to patients and physicians alike and result in unintended negative consequences. This review explores the aims of health care reform, the national efforts to create a culture of quality and safety, the principles of quality improvement, and how these principles can be applied to patient care and medical practice.
美国医疗保健系统取得了许多巨大成就,但在提高质量、可及性和成本控制方面仍存在改进空间。按服务收费的医疗保健模式正在向基于价值的医疗转变,这将要求在质量保证和成本降低方面承担责任。因此,许多医疗保健实体正在围绕一项全国性要务,将医疗保健提供者、管理人员、监管机构和患者团结起来,以营造安全文化并开发医疗保健系统,从而提高医疗保健质量。然而,患者安全和质量文化需要对结果进行严格评估,虽然有众多数据收集和决策支持工具可协助进行质量评估和绩效改进,但这些数据的公开报告可能会让患者和医生都感到困惑,并导致意想不到的负面后果。本综述探讨了医疗保健改革的目标、营造质量和安全文化的全国性努力、质量改进的原则,以及这些原则如何应用于患者护理和医疗实践。