Pendergrass P W, Abel R L, Bing M, Vaughn R, McCauley C
Texas Medical Foundation, Austin 78746-5799, USA.
Tex Med. 1998 Jul;94(7):54-60.
The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.
德克萨斯医学基金会是德克萨斯州的质量改进组织，为医疗保险人群开展地方质量改进项目。这些项目是作为医疗保健财务管理局实施的医疗保健质量改进计划的一部分而制定的。地方质量改进项目的目标是与医疗服务提供者合作，识别并减少医疗服务中对结果产生负面影响的无意差异的发生率。质量改进项目的成功有两个关键因素。首先，与基于隐含标准的同行评审不同，质量改进必须基于明确的标准。这些标准代表了医疗服务中的关键步骤，已被证明可改善特定疾病的治疗结果。其次，质量改进必须与医疗保健界合作进行。因此，医疗保健界必须在质量改进项目的设计和评估以及由此产生的质量改进计划的设计和实施中发挥不可或缺的作用。具体而言，本文提供了从同行评审向质量改进转变的历史视角。它讨论了制定和实施地方质量改进项目所使用的关键步骤，包括主题选择、质量指标制定、合作者招募以及绩效/改进的衡量。文中描述了两个德克萨斯医学基金会的项目，以突出当前的方法并说明质量改进项目的影响。
