Saturno P J, Palmer R H, Gascón J J
Department of Public Health and Preventive Medicine, University of Murcia School of Medicine, Spain.
Int J Qual Health Care. 1999 Dec;11(6):487-96. doi: 10.1093/intqhc/11.6.487.
Physicians' agreement with quality evaluation criteria, and estimates of their own and their colleagues' compliance with these criteria were compared with actual compliance.
Physicians practicing in 10 health centers in Spain defined 13 quality evaluation criteria for two patient conditions (upper respiratory infections and high serum cholesterol). Compliance with criteria was measured by an external team, using random samples of medical records stratified by condition in each health center (n= 1,000). Concurrently, physicians were surveyed regarding agreement with the criteria, and were asked to estimate their own and their health center's rate of compliance with these criteria.
Agreement ratings varied from 5.9 to 9.1 on a 10-point scale. Actual compliance rates ranged from 1.8 to 91.7% of records. Agreement correlated significantly with self-reported compliance but not with actual compliance. Estimates of one's own and one's health center compliance were positive and significantly correlated for all criteria, but were significantly higher for oneself than for one's health center for six of 13 criteria.
Wide variation in physicians' agreement on quality criteria and in actual performance reveal a lack of clear guidelines. Agreement on criteria did not always translate into compliance with criteria. Physicians tended to rate their own performance as better than the average of their peers, suggesting that aggregate data may not influence physicians to change. Self-estimate of one's own or one's colleagues performance is not a good proxy for actual performance so that peer ratings are of dubious value for performance appraisal.
将医生对质量评估标准的认同度，以及他们对自身和同事遵守这些标准情况的估计，与实际遵守情况进行比较。
在西班牙10家健康中心执业的医生针对两种患者病情（上呼吸道感染和高血清胆固醇）确定了13项质量评估标准。由一个外部团队通过对每个健康中心按病情分层的病历随机样本（n = 1000）来衡量标准的遵守情况。同时，对医生进行调查，询问他们对标准的认同度，并要求他们估计自己和所在健康中心遵守这些标准的比率。
在10分制的评分中，认同度评分从5.9到9.1不等。实际遵守率在记录的1.8%至91.7%之间。认同度与自我报告的遵守情况显著相关，但与实际遵守情况无关。对于所有标准，对自身和所在健康中心遵守情况的估计都是积极的且显著相关，但在13项标准中的6项上，对自己的估计显著高于对所在健康中心的估计。
医生在质量标准认同度和实际表现方面存在很大差异，这表明缺乏明确的指导方针。对标准的认同并不总是转化为对标准的遵守。医生倾向于将自己的表现评价得比同行平均水平更好，这表明汇总数据可能不会促使医生做出改变。对自己或同事表现的自我评估并不能很好地代表实际表现，因此同行评分在绩效评估中的价值存疑。
