评估医疗保健质量的明确标准的优点和局限性。

Advantages and limitations of explicit criteria for assessing the quality of health care.

作者信息

Donabedian A

出版信息

Milbank Mem Fund Q Health Soc. 1981 Winter;59(1):99-106.

Abstract

Explicit criteria for assessing the quality of health care should appeal to practitioners because such criteria make possible consistent judgments, openly arrived at. The process of their formulation encourages more critical scrutiny of current practice, identifying what the generality of practitioners can accept, and what is still doubtful. But, as instruments of social control, explicit criteria are a two-edged sword-vehicles for the best that medicine can offer, or instruments of institutionalized and pervasive error. Therefore, it is important to see who controls the criteria, whose perspectives and interests they serve, and what images of quality they render at once concrete and dominant.

摘要

评估医疗保健质量的明确标准应该对从业者具有吸引力，因为这些标准能够使人们做出一致的判断，而且是公开达成的。制定这些标准的过程会促使对当前的医疗实践进行更严格的审查，确定大多数从业者能够接受的内容以及仍存疑问的内容。但是，作为社会控制的手段，明确标准是一把双刃剑——它既可以成为医学所能提供的最佳成果的载体，也可能成为制度化且普遍存在的错误的工具。因此，了解谁控制这些标准、它们服务于谁的观点和利益，以及它们呈现出什么样的具体且占主导地位的质量形象非常重要。