将实践指南转化为质量指标的陷:从VA绩效测量中吸取的经验教训
Louise C Walter1, Natalie P Davidowitz, Paul A Heineken
1Division of Geriatrics, San Francisco VA Medical Center, and the University of California, San Francisco, CA 94121, USA. louisew@itsa.ucsf.edu
JAMA
|May 27, 2004
概括
医疗保健中的绩效指标,比如结肠直肠癌查的坚持,可能不会准确地反映医疗保健的质量. 考虑患者的疾病严重程度和偏好对于准确的质量评估至关重要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
- 临床实践指南 临床实践指南
背景情况:
- 退伍军人事务部 (VA) 运营着美国大型医疗保健系统,其质量测量实践影响国家标准.
- VA质量测量依赖于遵守基于证据的实践指南,更高的遵守表明更好的护理.
- 将临床指导方针转化为质量评估的绩效指标提出了概念上的挑战.
研究的目的:
- 将实践指南转化为质量措施时的概念问题.
- 为了说明基于指南的绩效指标的遵守率如何可能是癌症查实际质量的糟糕指标.
- 倡导使用绩效指标来定义医疗保健质量的更平衡的观点.
主要方法:
- 从指导方针转换为措施的概念分析.
- 在VA设施进行结直肠癌查的案例研究分析.
- 在绩效测量设计和解释中的陷的识别.
主要成果:
- 性能测量可能不准确地评估质量,因为患者群体中未解决的疾病严重程度.
- 如果不能将查与诊断程序区分开来,可能会扭曲查目标率.
- 忽视患者偏好和临床医生的判断在评分绩效指标时,可能会误导护理质量.
结论:
- 对绩效指标的遵守率并不总是等同于护理质量,特别是在结直肠癌查中.
- 患者的并发症和对查的偏好等因素可以使不进行查成为高质量的决定.
- 性能指标需要更细致的规范和解释,以准确反映质量,避免高测试率与良好的护理混.
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