関連する実験動画
パイ・フォー・パフォーマンス・プログラムで使用される高血圧のパフォーマンスの測定は,医学的に複雑な患者をケアする人を罰しますか?
Laura A Petersen1, Lechauncy D Woodard, Louise M Henderson
1MPH, Health Services Research and Development (152), Houston Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA. laurap@bcm.edu
Circulation
|June 3, 2009
まとめ
高血圧を含む複数の慢性疾患を患っている患者は,より質の高いケアを受けています. 患者のケアに対する満足度は,共存する疾患の数によって異なります.
科学分野:
- 医療サービス 研究 医療サービス
- クリニカル・クオリティ・メジャーメント
- 慢性疾患管理について
背景:
- 性能測定は,複数の慢性疾患の患者をケアする医療従事者に不利な影響を与える可能性があるという懸念がある.
- この研究では,併発性疾患が高血圧のケア品質と患者の認識に与える影響を調査しました.
研究 の 目的:
- 併存する疾患が,高血圧ケアの質にどのように影響するか調べる.
- 併合性疾患の負担と関連して,患者のケア品質に対する認識を評価する.
主な方法:
- 高血圧の141,609人の退役軍人を分析した.
- 患者は,高血圧と一致するおよび/または不一致する共疾患に基づいて分類されました.
- ロジスティック回帰では,併合性疾患の種類/数と,高品質の高血圧ケアを受けることとの関連性を評価した.
主要な成果:
- コンコンダント,ディスコダント,または両タイプの併発性疾患を有する患者は,高品質の高血圧治療を受ける確率は,コンコンダント,ディスコダント,または両タイプの併発性疾患を持たない患者と比較して高かった.
- これらの結果は,疾患の重症度および医療利用率を調整した後も維持された.
- 患者の満足度評価は,併発性疾患の存在または数値と関連していなかった.
結論:
- 懸念に反して,より大きな医療的複雑性を持つ患者は,高品質の高血圧ケアを受ける可能性が高くなりました.
- 患者の主観的なケア品質評価は,併発症状態によって変化しなかった.
- 研究結果は,複雑な患者のケアを行う医療提供者が,現在の品質指標によって罰せられないかもしれないことを示唆しています.
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