メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係 メディケアの病院間の関係
Rachel M Werner1, Eric T Bradlow
1Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa, USA. rwerner@mail.med.upenn.edu
JAMA
|December 14, 2006
まとめ
Hospital Compareのパフォーマンス指標は,患者の死亡率の低下とわずかな,しかし有意な相関を示しています. 患者のアウトカムとより密接に連携した対策を作成するために,さらなる開発が必要です.
科学分野:
- 医療の質 医療の質とは
- 医療サービス 研究 医療サービス
- クリニカルアウトカム
背景:
- 米国の病院の医療の質は,ますます懸念されています.
- Medicare & Medicaid Services (CMS) のセンターは,病院のパフォーマンスを報告するために,Hospital Compareを導入しました.
- CMSプロセスのパフォーマンスの測定値と病院レベルの患者のアウトカムとの関係は不明である.
研究 の 目的:
- 病院比較プロセスの測定値が病院リスク調整死亡率と相関し,予測するかどうかを評価する.
- 患者の生存に関する品質指標の予測力を評価する.
- 性能測定基準の遵守の臨床的意義を決定するために.
主な方法:
- 病院比較で米国の急性ケア病院の2004年のデータを分析した横断的な研究.
- 急性心筋梗塞,心不全,肺炎の10のプロセス性能測定値を調べました.
- リスク調整された死亡率 (入院,30日,1年) のメディケアパートA請求データとパフォーマンスの測定値を比較した.
主要な成果:
- トップクォーティル (75パーセント) の病院は,下部クォーティル (25パーセント) に比べて死亡率が低いことを示しました.
- 急性心筋梗塞では,パフォーマンス差が0.005から0.012の死亡率低下と相関していた.
- 心不全や肺炎では,パフォーマンスメーターの遵守は,死亡率の減少が小さく,時には統計的に有意であった.
結論:
- 病院比較プロセスのパフォーマンス指標は,病院のリスク調整死亡率と統計的に有意な関連性を示しています.
- パフォーマンス指標に関連した死亡率の観察された差異は比較的小さい.
- 将来の取り組みは,患者の結果とより強く,より直接的に結びついているパフォーマンス指標の開発に重点を置くべきです.
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