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Relación de la carga de casos de pacientes de los médicos de atención primaria con la medición de la calidad y el
David J Nyweide1, William B Weeks, Daniel J Gottlieb
1Office of Research, Development, and Information, Centers for Medicare & Medicaid Services, 7500 Security Blvd, C3-21-28, Baltimore, MD 21244, USA. david.nyweide@cms.hhs.gov
JAMA
|December 10, 2009
Resumen
La mayoría de las prácticas de atención primaria carecen de suficientes pacientes de Medicare para medir de manera confiable las diferencias de calidad y rendimiento de costos. Las prácticas más grandes muestran potencial para evaluaciones de rendimiento más precisas en la atención ambulatoria.
Área de la Ciencia:
- Servicios de salud Servicios de salud Investigación Investigación.
- Medición de la calidad médica Medición de la calidad médica.
- Política de la atención de la salud Política de la atención médica.
Sus antecedentes:
- La medición estadísticamente confiable del rendimiento del médico requiere volúmenes de pacientes adecuados.
- La evaluación de la calidad del médico y el rendimiento de los costos es crucial para la mejora del sistema de salud.
Objetivo del estudio:
- Para determinar si las prácticas de los médicos de atención primaria tienen suficientes pacientes de Medicare anualmente para detectar diferencias significativas en las medidas de calidad y costos ambulatorios.
- Evaluar la viabilidad de las comparaciones de rendimiento a nivel de práctica utilizando datos de Medicare.
Principales métodos:
- Enlazó a los médicos de atención primaria de los Estados Unidos con las prácticas utilizando la base de datos de IMS Health.
- Calculó las cargas de pacientes requeridas para detectar diferencias del 10% en las medidas de calidad y costo.
- Utilizó datos de muestras del 20% de Medicare Parte B de 2005 para estimar el número de casos en la práctica.
Principales resultados:
- La carga mediana de casos de Medicare por consultorio fue de 260 pacientes.
- Las cargas de casos suficientes para los costos ambulatorios y algunas medidas de calidad (mammografía, A1c) variaron según el tamaño de la práctica.
- Ninguna de las prácticas tenía suficientes pacientes para evaluar de manera confiable las tasas de hospitalización evitable o de readmisión de CHF.
Conclusiones:
- Pocas prácticas de atención primaria son lo suficientemente grandes como para medir de manera confiable las diferencias del 10% en las métricas comunes de calidad y rendimiento de costos.
- El tamaño de la práctica es un factor crítico en la capacidad de realizar evaluaciones de rendimiento significativas.
- Las limitaciones actuales de datos pueden dificultar la evaluación precisa del rendimiento del médico en prácticas más pequeñas.
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