对不公平现象采取行动:质量与安全的结构范式

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Tara A Burra, Christine Soong, Brian M Wong
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引用次数: 0

摘要

作为质量改进和患者安全(QIPS)的实践者,我们渴望利用改进方法改善对所有患者、护理人员和家属的护理。虽然我们对团队进行了培训,以认真实施科学的改进方法,但对于如何有效地将公平纳入 QIPS 工作,我们却知之甚少。是应该开展更多专门针对公平的项目,还是应该将公平纳入所有质量改进工作中?在改进工作中忽视公平领域,就会忽视系统性的偏见,并可能加剧医疗结果的不公平。如何衡量不公平,以及越来越多的人呼吁重新构建健康公平数据的衡量、展示和分析,是这一讨论的核心。在本期《英国医学杂志质量与安全》(BMJ Quality and Safety)上,Arrington 及其同事1 提出了从种族公平角度收集、共享和解释质量数据的策略。作者首先描述了按种族和民族对质量数据进行分层的问题,这可能会使种族或民族是健康结果差异的原因这一错误观念永久化,并阻碍团队识别健康不平等的内在结构性或系统性根源。他们提供了重新构想数据收集和展示的具体实例,这些实例具有可操作性和可行性。这些例子包括在描述种族群体之间的差异之外考虑根本原因、公平地选择参照点(例如,避免使用白人患者的结果作为参照点)、呈现最具体的汇总水平(例如,将种族识别为 "中国人 "而非 "亚洲人")、收集优势数据(例如,描述具有积极结果的群体)而非缺陷数据、衡量种族主义而非种族以及与社区合作伙伴合作。利用这一框架,叙述的重点就从种族和族裔转移到造成健康不平等的不公正制度、结构和做法上。正如 Arrington 及其同事1 所阐述的那样,采用种族公平视角来解释分层 QIPS 数据是一项基本技能,它可以...
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Taking action on inequities: a structural paradigm for quality and safety
As quality improvement and patient safety (QIPS) practitioners, we aspire to improve care for all patients, caregivers and families using improvement methods. While teams are trained to carefully implement the science of improvement, less is known of how to effectively incorporate equity into QIPS work. Should there be more projects focused specifically on equity, or should equity be embedded into all quality improvement? Inattention to the equity domain in improvement efforts ignores systemic biases and can worsen inequities in health outcomes. How to measure inequity, and growing calls to reframe health equity data measurement, presentation and analysis are central to this discourse. In this issue of BMJ Quality and Safety , Arrington and colleagues1 offer strategies to collect, share and interpret quality data using a racial equity lens. The authors first describe the problems with stratifying quality data by race and ethnicity, which can perpetuate the false notion that race or ethnicity is responsible for differences in health outcomes and inhibit teams from identifying embedded structural or systemic root causes of health inequities. They provide concrete examples of reimagining data collection and presentation that are actionable and feasible. These include considering root causes beyond describing differences among racial groups, choosing reference points equitably (eg, avoiding using outcomes of white patients as reference points), presenting the most specific level of aggregation (eg, identifying race as ‘Chinese’ rather than ‘Asian’), collecting data on strengths (eg, describing groups with positive outcomes) rather than deficits, measuring racism instead of race and collaborating with community partners. Using this framework, the narrative shifts away from race and ethnicity to a focus on unjust systems, structures and practices responsible for health inequities. As articulated by Arrington and colleagues,1 adopting a racial equity lens to the interpretation of stratified QIPS data is an essential skill that …
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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