PubMed · 16403768
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Roger Taylor, Richard Hillestad. Creating the future.. https://doi.org/10.1377/hlthaff.25.1.294-a
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Clinical utility is an increasingly used concept in health care, but one that lacks an agreed formal definition or conceptualization. In this article, I show that the term is commonly used as a synonym for studies of clinical effectiveness and/or economic evaluations and argue that further factors relating to everyday working practice should be included under its auspices. I go on to develop a multi-dimensional model that outlines four factors in practitioners' judgements about clinical utility: appropriateness, accessibility, practicability, and acceptability.
OBJECTIVE: To explore problems and obstacles of hospitals in Thailand implementing quality management systems according to the hospital accreditation (HA) standards. DESIGN: Questionnaire survey. SETTING: Thirty-nine hospitals in all 13 regions of Thailand. PARTICIPANTS: A total of 728 health care professionals and 41 surveyors of the national accreditation program. MAIN OUTCOME MEASURES: Health care professionals' and surveyors' opinions on problems and obstacles in 24 items representing Thailand HA standards. RESULTS: The response rates were 94.9 and 73.2% in health care professionals and surveyors, respectively. More than 90% of both groups thought that there had been problems in the items such as 'quality improvement (QI) activities' and 'integration and utilization of information'. The items considered by health care professionals as major obstacles included 'adequacy of staff' (34.6%) and 'integration and utilization of information' (26.6%), for example. For surveyors, 'integration and utilization of information' was ranked highest as presenting a major obstacle (43.9%), followed by 'discharge and referral process' (31.7%) and 'medical recording process' (29.3%). The rank orders for the 24 items as problems and major obstacles were similar in both groups (Spearman's rank correlation 0.436, P = 0.033 and 0.583, P = 0.003, respectively). Surveyors had a higher degree of concern and paid more attention to care-related items than health care professionals. CONCLUSIONS: Health care professionals have been facing many problems with multidisciplinary process-related issues of the accreditation standard, whereas surveyors might have had some difficulties in conveying the core QI concepts to them. The findings might be explained by the effects of health care reform on the underlying accreditation principles. One of the strategies to respond to the situation was presented.