Fuhlbrigge Anne L, Carey Vincent J, Finkelstein Jonathan A, Lozano Paula, Inui Thomas S, Weiss Scott T, Weiss Kevin B
Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Am J Manag Care. 2005 May;11(5):325-30.
The most widely used performance measure for asthma, the Health Plan Employer Data and Information Set (HEDIS), has been criticized because the delay between classification (year 1) and assessment of medication dispensing (year 2) may produce a "misalignment" and weaken the validity of the measure.
To examine whether a previously observed association between the HEDIS performance measure and asthma-related emergency department visits is robust when the period between the classification and outcome assessment is evaluated during a 2-year period as defined.
Children (N = 2766) aged 3 to 15 years enrolled in 1 of 3 managed care organizations with at least 1 asthma diagnosis listed for a hospitalization, an emergency department visit, or an ambulatory encounter and at least 2 consecutive years of data for analysis from July 1996 through June 1999 were identified.
Children did not consistently meet the HEDIS criteria for persistent asthma, and 24% to 28% of children did not requalify in year 2 of observation. Multivariate regression models showed that a protective relationship between controller medication dispensing and asthma-related emergency department visits was no longer seen among children meeting the HEDIS criteria for persistent asthma when the total period of observation is extended to 2 years (odds ratio, 0.7; 95% confidence interval, 0.4-1.2).
Our results suggest that the variable nature of asthma may affect how the HEDIS performance measure should be used for assessing quality of care. The period between identification of the target population and performance assessment should be closely related in time.
哮喘最广泛使用的绩效衡量指标，即健康计划雇主数据与信息集（HEDIS），受到了批评，因为分类（第1年）与药物配给评估（第2年）之间的延迟可能会产生“失调”，并削弱该指标的有效性。
当按照定义在2年期间评估分类与结果评估之间的时间段时，检验先前观察到的HEDIS绩效指标与哮喘相关急诊就诊之间的关联是否稳健。
确定了年龄在3至15岁之间的儿童（N = 2766），这些儿童参加了3个管理式医疗组织中的1个，有至少1次因住院、急诊就诊或门诊就诊列出的哮喘诊断，并且有1996年7月至1999年6月至少连续2年的分析数据。
儿童并非始终符合持续性哮喘的HEDIS标准，并且24%至28%的儿童在观察的第2年没有重新达标。多变量回归模型显示，当观察总时长延长至2年时，在符合持续性哮喘HEDIS标准的儿童中，控制药物配给与哮喘相关急诊就诊之间的保护关系不再明显（比值比，0.7；95%置信区间，0.4 - 1.2）。
我们的结果表明，哮喘的多变性质可能会影响HEDIS绩效指标在评估医疗质量时的使用方式。目标人群识别与绩效评估之间的时间段在时间上应紧密相关。
