从措施到行动:整合质量措施能否为质量改进决策提供全系统的见解?
Inas S Khayal1,2,3,4, Jordan T Sanz4
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA inas.khayal@dartmouth.edu.
整合多个质量措施并没有提供对医疗保健质量的系统理解. 需要使用使用行政索赔数据的新数学方法,以改善质量改进举措的决策.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 生物统计学 生物统计学
背景情况:
- 医疗保健质量改善面临着由于措施分散和缺乏系统理解的挑战.
- 当前的质量改进策略经常使用一对一的度量改善方法,导致意想不到的后果.
- 整合多个质量指标以提供对护理质量的整体观点的潜力在很大程度上仍未被探索.
研究的目的:
- 调查是否整合多个终身癌症护理质量指标可以在整个医疗保健系统中产生一致的系统洞察力.
- 确定从行政索赔数据中得出的现有质量指标是否可以结合起来,以揭示护理利用模式.
主要方法:
- 采用数据驱动的分析策略,使用多达八种公开可用的终身癌症护理质量指标.
- 分析包括相关性,主要组件和层次聚类技术,跨越和在54个癌症中心内进行.
- 为了评估质量措施的整合,进行了92次实验.
主要成果:
- 整合54个中心的质量措施并没有对护理质量结构产生一致的系统洞察力.
- 该研究发现,质量测量计算缺乏了解患者护理途径所需的相互连接信息.
- 行政索赔数据虽然用于质量测量,但没有有效地整合,以提供全面的护理服务.
结论:
- 整合现有的质量措施并不能为有效的质量改进决策提供必要的系统信息.
- 需要新的数学构造来从行政索赔数据中提取互连信息.
- 开发新的分析方法对于支持医疗保健系统质量改善至关重要.
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