初级保健医生患者病例数量与质量和成本绩效测量的关系
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
概括
大多数初级保健机构缺乏足够的医疗保险患者来可靠地衡量质量和成本效益差异. 更大的实践显示出在门诊护理中更准确的绩效评估的潜力.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗质量测量 医疗质量测量
- 医疗保健政策 医疗保健政策
背景情况:
- 在统计学上可靠地衡量医生的表现需要足够的患者体积.
- 评估医生质量和成本绩效对于改善医疗保健系统至关重要.
研究的目的:
- 为了确定初级保健医生实践是否有足够的医疗保险患者每年检测出门诊质量和成本措施的有意义差异.
- 评估使用医疗保险数据进行实践水平绩效比较的可行性.
主要方法:
- 将美国初级保健医生与使用IMS健康数据库的实践联系起来.
- 计算所需的患者病例量,以检测质量和成本指标的10%差异.
- 利用2005年医疗保险B部分20%的样本数据来估计实践中的病例数量.
主要成果:
- 每个诊所的医疗保险病例中位数为260名患者.
- 足够的病例数量用于门诊费用和一些质量测量 (乳腺造影,A1c) 根据诊所规模而异.
- 没有实践有足够的患者可靠地评估可预防的住院治疗或CHF再入院率.
结论:
- 很少有初级保健实践足够大,可以可靠地测量常见的质量和成本绩效指标中的10%差异.
- 实践规模是进行有意义的绩效评估的能力的一个关键因素.
- 当前数据的局限性可能会阻碍在较小实践中准确评估医生的表现.
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