探索医院复合性能指标的行为:冠状动脉旁路手术的一个例子
Sean M O'Brien1, Elizabeth R DeLong, Rachel S Dokholyan
1Duke Clinical Research Institute, Durham, NC 27715, USA. obrie027@mc.duke.edu
Circulation
|December 7, 2007
概括
用于绩效排名和财务激励的医院综合分数,重视过程措施,而不是生存等结果. 替代方法可以提供更平衡的医院绩效评估.
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
- 医疗信息学 医疗信息学
背景情况:
- 综合分数是医院绩效评估和财政激励的标准.
- 医疗保险和医疗补助服务中心的医院质量激励示范 (HQID) 使用复合分数.
- 缺乏对HQID复合计算方法的验证.
研究的目的:
- 为了验证HQID复合分数方法.
- 评估过程对结果措施对医院排名的影响.
- 探索平衡绩效评估的替代方法.
主要方法:
- 用530家医院的胸部外科医生协会数据复制HQID方法.
- 在冠状动脉绕道手术中使用了6个国家认可的绩效指标 (5个过程,1个生存率).
- 分析了通过生存成分解释的差异,并比较了各种方法的排名.
主要成果:
- 综合得分主要通过过程测量来确定,生存率仅解释了4%的差异.
- "一切或没有"的方法也是以过程为主.
- 根据使用的复合方法,医院排名差异很大 (高达60%).
结论:
- 目前的综合绩效指标不成比例地重视过程而不是结果,导致医院排名分歧.
- 其他方法,包括统计标准化,可以产生更一致和平衡的过程结果评估.
- 为了准确的医院绩效评估,需要精细的复合方法.
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