Shortell S M, Bennett C L, Byck G R
University of California, School of Public Health, Berkeley 94720-7360, USA.
Milbank Q. 1998;76(4):593-624, 510. doi: 10.1111/1468-0009.00107.
The literature on continuous quality improvement (CQI) has produced some evidence, based on nonrandomized studies, that its clinical application can improve outcomes of care while reducing costs. Its effectiveness is enhanced by a nucleus of physician involvement, individual practitioner feedback, and a supportive organizational culture. The few randomized studies, however, suggest no impact of CQI on clinical outcomes and no evidence to date of organization-wide improvement in clinical performance. Further, most studies address misuse issues and avoid examining overuse or underuse of services. The clinical application of CQI is more likely to have a pervasive impact when it takes place within a supportive regulatory and competitive environment, when it is aligned with financial incentives, and when it is under the direction of an organizational leadership that is committed to integrating all aspects of the work.
关于持续质量改进（CQI）的文献基于非随机研究得出了一些证据，表明其临床应用可在降低成本的同时改善护理结果。医生参与的核心、个体从业者反馈以及支持性的组织文化可增强其有效性。然而，少数随机研究表明CQI对临床结果没有影响，且迄今为止没有证据表明全组织的临床绩效有所改善。此外，大多数研究关注的是滥用问题，而避免考察服务的过度使用或使用不足情况。当CQI在支持性的监管和竞争环境中实施、与财务激励措施保持一致且在致力于整合工作各方面的组织领导的指导下进行时，其临床应用更有可能产生广泛影响。
