Quality Improvement for Whom?
本文探讨医疗质量改进中谁真正受益的问题，回顾了1999年《人非圣贤孰能无过》报告揭示的医疗错误致死数据及后续《跨越质量鸿沟》报告提出的六项改进目标，适合关注医疗质量与患者安全的读者。
mproving the quality of almost anything is a laudable goal.However, when it comes to the improvement of health care, a critical question to ask is, who actually benefits from the improvement?Is it the patient, the clinician, the financial officer and the health care corporation, the population at large, other entities, no one, or everyone?To understand how the current quality improvement in health care movement started, it is important to review a bit of history.In 1999 the Institute of Medicine (IOM) published a hugely influential report, To Err Is Human, which revealed that up to 98,000 US citizens were dying each year as a result of medical errors.Although most of the errorcaused deaths occurred in hospitals, other settings such as doctor's offices, outpatient surgical centers, and nursing homes were also involved.In addition, the cost of medical errors resulting in injuries was estimated to be between $17 billion and $29 billion, with health care costs accounting for more than 50% of the total. 1 Two years later the IOM published another report, Crossing the Quality Chasm, in which 6 specific aims for improvement in health care were outlined.These included avoiding injuries to patients from care needed to help them; providing services based on scientific knowledge to all who could benefit and refraining from providing services to those unlikely to benefit (avoiding underuse and overuse); providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide clinical decisions; reducing waits and sometimes harmful delays for both those who receive and those who give care; avoiding waste such as waste of equipment, supplies, ideas, and energy; and providing care that does not differ in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. 2 The first report revealed a major problem in health care and the second report outlined aims to help remedy the situation.The aims were reasonable and designed to improve patient