Nash D B, Carpenter C E
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
Acad Med. 1995 Mar;70(3):239-41. doi: 10.1097/00001888-199503000-00017.
It is widely acknowledged that academic medical centers (AMCs) must be committed to appropriate resource use and to the clinical evaluation research needed to accomplish this goal. The authors report the results of a national survey and series of site visits to further elucidate the role of centralized mechanisms for evaluating clinical practice, called clinical evaluation units (CEUs). A CEU is characterized by a separate operating unit with a physician director on at least a half-time basis complemented by data analysts, information system specialists, or other technical staff.
In April 1993, the authors mailed a survey instrument to the 60 hospitals that were members of the University Hospital Consortium (UHC) and to 28 non-UHC teaching hospitals. After four follow-up mailings and telephone reminders, a 69% response rate (61 responses) was achieved. The survey instrument highlighted areas such as the environment in which the hospitals operated, the structure and organization of clinical evaluation, the process of how these activities were carried out, and the outcomes from the CEUs.
Twenty-two respondents had centralized mechanisms that met the authors' definition of a CEU. Support for most CEUs came from hospital administrations and not from medical school deans. An alternative structure emerged from the analysis: 18 respondents indicated that they did not have CEUs but that clinical evaluation activities were integrated into the medical staff hierarchy and dispersed throughout departments that reported to a physician executive.
The discipline of clinical evaluation is in its infancy in teaching institutions. Many AMCs do not have a coordinated program of clinical evaluation; others are just starting. Clinical evaluation must become integrated into medical education and hospital operations to serve as one aspect of academic medicine's response to health care reform.
人们普遍认为，学术医疗中心（AMC）必须致力于合理利用资源，并开展实现这一目标所需的临床评估研究。作者报告了一项全国性调查的结果以及一系列实地考察情况，以进一步阐明名为临床评估单位（CEU）的集中式临床实践评估机制的作用。CEU的特点是有一个独立的运营单位，至少有一位半职的医师主任，并有数据分析师、信息系统专家或其他技术人员辅助。
1993年4月，作者向大学医院协会（UHC）的60家成员医院以及28家非UHC教学医院邮寄了调查问卷。经过四次后续邮寄和电话提醒后，回复率达到了69%（61份回复）。调查问卷突出了医院运营环境、临床评估的结构与组织、这些活动的开展过程以及CEU的成果等方面。
22名受访者拥有符合作者对CEU定义的集中式机制。大多数CEU的支持来自医院管理层，而非医学院院长。分析中出现了另一种结构：18名受访者表示他们没有CEU，但临床评估活动已融入医务人员层级体系，并分散在向医师主管汇报的各个部门。
临床评估学科在教学机构中尚处于起步阶段。许多AMC没有协调一致的临床评估项目；其他机构才刚刚起步。临床评估必须融入医学教育和医院运营，成为学术医学应对医疗改革的一个方面。
