Guillain H, Raetzo M A
Institute de santé et d'économie, Lausanne.
Schweiz Med Wochenschr. 1997 Mar 29;127(13):541-8.
Quality of care is growing concern among health care professionals and managers. As a multidimensional concept, it cannot be reduced to simple customer satisfaction. Taking into account the views of the three major players in the health care system-patients, providers and payers-quality can be defined as the capacity to satisfy patients' needs according to professional knowledge and within available resources. Efficacy, efficiency, appropriateness, acceptability, legitimacy and equity are dimensions of health care quality. Contrary to popular belief, quality is neither maximum performance, nor satisfaction at all costs, nor punishment or elimination of "bad apples". In ambulatory medicine, quality implies first of all the ability to master the processes occurring during an office visit. However, although history taking and physical examination are the cornerstones of medical practice, they have not been well studied. Improving quality of care in the ambulatory sector will require better knowledge about medical decision-making processes, in particular identification of the most relevant information required for a decision and the optimal way of obtaining it in any specific clinical situation.
医疗服务质量日益受到医疗保健专业人员和管理人员的关注。作为一个多维度概念，它不能简单归结为客户满意度。考虑到医疗保健系统中三大主体——患者、提供者和支付方——的观点，质量可定义为根据专业知识并在可用资源范围内满足患者需求的能力。疗效、效率、适宜性、可接受性、合法性和公平性是医疗保健质量的维度。与普遍看法相反，质量既不是最高绩效，也不是不惜一切代价的满意度，更不是惩罚或淘汰“害群之马”。在门诊医疗中，质量首先意味着掌握门诊过程中发生的各种流程的能力。然而，尽管病史采集和体格检查是医疗实践的基石，但它们尚未得到充分研究。提高门诊医疗服务质量需要更好地了解医疗决策过程，特别是确定决策所需的最相关信息以及在任何特定临床情况下获取这些信息的最佳方式。
