基于家庭护理最小数据集的家庭护理质量指标（HCQIs）风险调整方法。
Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care.
作者信息
Dalby Dawn M, Hirdes John P, Fries Brant E
机构信息
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
出版信息
BMC Health Serv Res. 2005 Jan 18;5(1):7. doi: 10.1186/1472-6963-5-7.
BACKGROUND
There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC).
METHODS
A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI).
RESULTS
The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario.
CONCLUSIONS
Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the ranking of many individual home care providers.
背景
提高医疗保健领域的问责制受到越来越多的关注。因此，已开发出多种方法来比较家庭护理服务的质量。如果不同提供者的客户群体存在差异且未进行调整以考虑这些差异，那么这些比较可能会出现问题。本文探讨了基于家庭护理最低数据集（MDS-HC）对一组家庭护理质量指标（HCQI）进行风险调整的效果。
方法
加拿大安大略省的22家家庭护理提供者以及曼尼托巴省温尼伯地区卫生局（WRHA）使用MDS-HC收集了其客户的数据。这些评估数据用于为每个机构和两个地区生成HCQI。对比了三种类型的风险调整方法：a）仅客户协变量；b）客户协变量加上“机构入院概况”（AIP）以调整机构的确定和选择偏差；c）客户协变量加上入院病例组合指数（CMI）。
结果
两个人口中的平均年龄和性别分布非常相似。在19个经风险调整的HCQI中，安大略省社区护理接入中心（CCAC）在8个HCQI上的AIP调整值显著更高，表明入院时在这些质量问题上触发的倾向更大。平均而言，安大略省的未调整率比WRHA高0.3%。在使用AIP协变量进行风险调整后，安大略省的比率平均比WRHA低1.5%。在WRHA，个别机构的排名可能会下降，即风险调整后它们更有可能被列为表现最差的机构。安大略省的机构情况则相反。
结论
当家庭护理机构为具有不同特征的人群提供服务时，在比较不同提供者的护理质量时，风险调整至关重要。虽然这种调整对两个地区的影响相对较小，但它确实对许多个体家庭护理提供者的排名产生了重大影响。
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