プライマリーケア医師の患者さんのケースロードと,品質とコストパフォーマンスの測定との関係
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
まとめ
ほとんどのプライマリーケア・プラクティスは,品質とコスト・パフォーマンスの違いを確実に測定できる十分なメディケアの患者が不足しています. 大規模な診療所は, ambulatory care でより正確なパフォーマンスの評価の可能性を示しています.
科学分野:
- 医療サービス 研究 医療サービス
- 医療品質測定 医療品質測定について
- 保健医療政策について
背景:
- 統計的に信頼性の高い医師の業績測定には,十分な患者数が必要である.
- 医師の質とコストパフォーマンスの評価は,医療制度の改善に不可欠です.
研究 の 目的:
- プライマリケア医師の診療所で,毎年, ambulatoryの品質とコストの測定において有意義な差異を検出するのに十分なメディケア患者がいるかどうかを判断する.
- メディケアデータを用いて実務レベルでのパフォーマンス比較の実現可能性を評価する.
主な方法:
- IMS Healthのデータベースを利用して,米国のプライマリケア医師を診療所とリンクした.
- 品質とコストの測定における10%の差異を検出するために必要な患者のケースロードを計算しました.
- Medicare Part B 20%のサンプルデータを2005年から活用して,実務の症例数を推定しました.
主要な成果:
- 医療所のメディケアの平均症例数は260人でした.
- アムブラトリー費用をカバーする十分なケースロードと,いくつかの品質測定 (マンモグラフィー,A1c) は,診療所のサイズによって異なります.
- 予防可能な入院率やCHF再入院率を確実に見積もるのに十分な患者を診療所には持っていませんでした.
結論:
- 標準的な品質とコストパフォーマンスの指標における10%の差異を確実に測定できるほど大きなプライマリケア・プラクティスはほとんどありません.
- 実践の規模は,有意義な業績評価を実施する能力の重要な要因です.
- 現在のデータの制限は,小規模な診療所で医師のパフォーマンスの正確な評価を妨げることがあります.
さらに関連する動画
関連する概念動画
01:26Methods Of Healthcare Delivery System
3.9K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.9K
01:30Primary Healthcare Services
3.3K
Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
3.3K
01:11Purpose of Health Records I
1.8K
The vital purpose of health records is to provide a complete and accurate account of a patient's medical history, including communication, diagnostic and therapeutic orders, care planning, research, and quality review.
Here's a breakdown of how health records serve these purposes:
Here's a breakdown of how health records serve these purposes:
1.8K
01:15Methods of Documentation VI: Case Management Model
1.0K
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
For example, a patient with a chronic...
1.0K
01:30Health Information Technology and Healthcare Information System
1.7K
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
1.7K
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
631
Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
631