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丹麦医疗保健质量计划:通过使用质量改进合作来实现变革。

The Danish health care quality programme: Creating change through the use of quality improvement collaboratives.

机构信息

DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Olof Palmes Alle 15, Aarhus DK-8200, Denmark.

Department of Political Science, Aarhus University, Aarhus, Denmark.

出版信息

Health Policy. 2022 Aug;126(8):749-754. doi: 10.1016/j.healthpol.2022.05.019. Epub 2022 Jun 1.

Abstract

Policy-makers worldwide place quality in health care high on their agendas. Inspired by global trends within health care governance, there has been an increase in patient-oriented and network-based models for quality improvement. In 2015, the Danish Government introduced the Danish Health Care Quality Programme (DHCQP) for the entire Danish health care system in line with this development. For the first time in Denmark, the DHCQP introduced network-based quality improvement collaboratives (QICs) as a model for the implementation of a national quality improvement reform. This article presents the organisational set up and anticipated effects of using QICs within the DHCQP. The Danish set-up is related to the common international use of QICs and the existing evidence for their effectiveness and implementation. The analysis demonstrates a novel organisational set-up embedded in the organisation of the QICs. Furthermore, the article points to two main trends in the DHCQP, namely, centralisation of quality improvement strategies and integration of quality improvement work in clinical practices, and furthermore proposes a need for future research concerning implementation of QICs. Particularly, there is a need to investigate the different activities and organisational mechanisms in the implementation process and how these influence the implementation and functioning of QICs.

摘要

政策制定者在全球范围内将医疗保健质量置于其议程的重要位置。受全球医疗保健治理趋势的启发,出现了以患者为导向和基于网络的质量改进模式。2015 年,丹麦政府顺应这一发展,为整个丹麦医疗保健系统推出了丹麦医疗保健质量计划(DHCQP)。这是丹麦首次引入基于网络的质量改进合作组织(QIC),作为实施国家质量改进改革的模式。本文介绍了在 DHCQP 中使用 QIC 的组织设置和预期效果。丹麦的设置与 QIC 的常见国际用途以及现有证据证明其有效性和实施情况有关。分析表明,在 QIC 的组织中嵌入了一种新颖的组织设置。此外,本文还指出了 DHCQP 中的两个主要趋势,即质量改进策略的集中化和质量改进工作在临床实践中的整合,并进一步提出了对 QIC 实施情况进行未来研究的必要性。特别是,需要研究实施过程中的不同活动和组织机制,以及这些活动和机制如何影响 QIC 的实施和运作。

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