Valenstein Marcia, Mitchinson Allison, Ronis David L, Alexander Jeffrey A, Duffy Sonia A, Craig Thomas J, Barry Kristen Lawton
Department of Veterans Affairs, Serious Mental Illness Treatment, Research, and Evaluation Center, Ann Arbor, Mich, USA.
Am J Psychiatry. 2004 Jan;161(1):146-53. doi: 10.1176/appi.ajp.161.1.146.
Many health care organizations are giving feedback to mental health care providers about their performance on quality indicators. Mental health care providers may be more likely to respond to this feedback if they believe the indicators are meaningful and within their "sphere of influence." The authors surveyed frontline mental health care providers to elicit their perceptions of widely used indicators for quality monitoring in mental health services.
The survey was distributed to a stratified, random sample of 1,094 eligible mental health care providers at 52 Department of Veterans Affairs facilities; 684 (63%) returned the survey. The survey elicited perceptions of 21 widely used indicators in five quality domains (access, utilization, satisfaction, process, and outcomes). The data were analyzed with descriptive and multivariate methods.
Most mental health care providers (65%) felt that feedback about these widely used indicators would be valuable in efforts to improve care; however, only 38% felt able to influence performance related to these monitors and just 13% were willing to accept incentives/risk for their performance. Providers were most positive about satisfaction monitors and preferentially included satisfaction, access, and process monitors in performance sets to measure overall quality. Despite providers' relatively positive views of monitors, 41% felt that monitoring programs did not assist them in improving care. Providers cited numerous barriers to improving care processes.
Mental health care providers may be more receptive to monitoring efforts if satisfaction, access, and process monitors are emphasized. However, providers' views of monitoring programs appear to be less affected by concerns about specific monitors than by concerns about the accuracy of quality measurement and barriers to changing care processes.
许多医疗保健机构正在就心理健康护理提供者在质量指标方面的表现向他们提供反馈。如果心理健康护理提供者认为这些指标有意义且在其“影响范围内”，他们可能更有可能对这种反馈做出回应。作者对一线心理健康护理提供者进行了调查，以了解他们对心理健康服务中广泛使用的质量监测指标的看法。
该调查被分发给退伍军人事务部52个设施中1094名符合条件的心理健康护理提供者的分层随机样本；684人（63%）回复了调查。该调查引出了对五个质量领域（可及性、利用率、满意度、过程和结果）中21个广泛使用的指标的看法。数据采用描述性和多变量方法进行分析。
大多数心理健康护理提供者（65%）认为，关于这些广泛使用的指标的反馈在改善护理的努力中会很有价值；然而，只有38%的人觉得能够影响与这些监测相关的表现，只有13%的人愿意接受因其表现而给予的激励/承担风险。提供者对满意度监测指标最为认可，并在绩效评估中优先纳入满意度、可及性和过程监测指标以衡量整体质量。尽管提供者对监测指标的看法相对积极，但41%的人认为监测项目并未帮助他们改善护理。提供者列举了改善护理过程的众多障碍。
如果强调满意度、可及性和过程监测指标，心理健康护理提供者可能会更接受监测工作。然而，提供者对监测项目的看法似乎受对特定监测指标的担忧影响较小，而受对质量测量准确性的担忧以及改变护理过程的障碍影响较大。
