模拟整体医院质量星级评级使用随机测量权重
Benjamin D Pollock1, Daniel S Ubl2, Subashnie Devkaran2,3
1Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, Florida.
JAMA network open
|July 3, 2025
概括
很少有美国医院能够持续提供卓越的护理. 一项对2700家医院的研究发现,只有9%的医院是可靠的优秀医院,这凸显了需要超越当前评级的更好的质量测量.
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
- 医院绩效测量方法 医院绩效测量方法
背景情况:
- 现有的医院评级,如美国新闻和世界报道和医疗保险和医疗补助服务中心 (CMS) 总体医院质量星级评级衡量不同的结果,并显示弱相关性.
- 需要方法来定义和衡量可靠的卓越,定义为在所有质量指标上一致的高性能.
研究的目的:
- 通过CMS整体星级评级的45个质量指标来评估可靠卓越的新方法.
- 确定美国医院在所有质量指标中始终表现出色的比例.
主要方法:
- 一项横截面研究分析了所有美国医院的2023年和2024年的CMS整体星级评级数据.
- 进行了10万次模拟,随机加权45个质量指标,以计算每个医院的总结分数.
- 可靠的卓越被定义为在至少5万次模拟中获得90百分点的得分.
主要成果:
- 在2700家医院中,只有244家 (9.0%) 符合可靠卓越的定义.
- 只有不到三分之二的拥有5星CMS评级的医院实现了可靠的卓越.
- 虽然47.7%的医院在至少一个模拟中取得了卓越的成绩,但一致的高绩效很少见.
结论:
- 美国一小部分医院在所有质量指标上都显示出可靠的优异表现.
- 当前的医院评级系统可能无法完全捕捉到一致的高质量护理.
- 这些发现强调了需要改进的方法来识别提供始终卓越护理的医院.
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