医疗保险的医院之间的关系比较绩效指标和死亡率
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
概括
医院比较绩效指标显示,与患者死亡率的降低存在微小但显著的相关性. 需要进一步开发,以创建与患者结果更紧密的措施.
科学领域:
- 医疗保健的质量 医疗保健的质量
- 医疗保健服务研究 医疗服务研究
- 临床结果 临床结果
背景情况:
- 美国医院的护理质量越来越令人担忧.
- 医疗保险和医疗补助服务中心 (CMS) 推出了医院比较,以报告医院的表现.
- 在CMS流程性能指标和医院级患者结果之间的关系仍然不清楚.
研究的目的:
- 评估医院比较过程是否与预测医院风险调整死亡率相关.
- 评估质量指标对患者生存的预测能力.
- 为了确定性能测量遵守的临床意义.
主要方法:
- 横截面研究分析了来自美国急症医院的2004年数据.
- 对急性心肌梗塞,心力衰竭和肺炎的10个过程性能指标进行了检查.
- 将绩效指标与风险调整后死亡率的Medicare A部分索赔数据进行比较 (住院患者,30天,1年).
主要成果:
- 在上四分之一 (第75个百分位) 的医院,与下四分之一 (第25个百分位) 相比,死亡率较低.
- 对于急性心肌梗塞,性能差异与0.005至0.012.0的死亡率降低相关.
- 对于心力衰竭和肺炎,性能测量依从性显示出较小,尽管有时是统计学上显著的死亡率降低.
结论:
- 医院比较过程绩效指标显示,与医院风险调整后死亡率有统计学显著的关联.
- 与绩效指标相关的死亡率观察到的差异相对较小.
- 未来的努力应专注于开发具有更强大,更直接与患者结果联系的绩效指标.
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