初级保健质量改善框架是否考虑了公平性?
Alice Macdonald Barrell1, Lucy Johnson2, Amy Dehn Lunn2
1University of Cambridge School of Clinical Medicine, Cambridge, UK amb302@cam.ac.uk.
BMJ open quality
|July 25, 2024
概括
初级保健中的质量改进 (QI) 框架很少明确地解决健康公平问题. 目前的框架需要修订,以确保为所有人群公平分配医疗保健改进.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 健康 公平 卫生 公平
- 初级保健研究研究初级保健研究
背景情况:
- 质量改进 (QI) 倡议在全球范围内在医疗保健中实施,以提高患者护理.
- 然而,如果没有明确关注公平,QA项目可能会扩大弱势群体的健康差距.
- 初级保健QI框架将股权考虑纳入哪些程度仍然在很大程度上是未知的.
研究的目的:
- 调查在初级保健质量改善框架内考虑健康公平的情况.
- 评估现有的QI框架是否充分应对可能加剧的健康不平等问题.
主要方法:
- 在MEDLINE,EMBASE和相关网站的全面搜索中,确定了初级保健QI框架.
- 一个专家小组完善了框架清单.
- 针对所选框架的指导文件使用NVivo进行了专题分析.
主要成果:
- 对15份QI指导文件的分析显示,对公平或针对弱势群体的有针对性的干预措施的明确讨论有限.
- 不平等问题通过患者参与策略和人口定位来间接解决.
- 在分析的文件中观察到,主要关注效率而不是股权.
结论:
- 初级保健QI框架表明,对健康公平的考虑不足.
- 当提到公平时,它往往是隐含的,并受到各种解释的约束.
- 框架需要明确的修订,以优先考虑公平,确保在所有患者群体之间公平地分配QI利益.
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