Bierman A S, Lawrence W F, Haffer S C, Clancy C M
Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA.
Health Serv Res. 2001 Dec;36(6 Pt 2):90-109.
the Medicare Health Outcomes Survey (HOS), a new quality measure in the Health Plan Employer Data and Information Set, is designed to assess physical and mental functional health outcomes of Medicare beneficiaries enrolled in Medicare+Choice organizations. We discuss the rationale for the HOS measure together with methodologic challenges in its use and interpretation, using descriptive data from the baseline Medicare HOS to illustrate some of these challenges.
DATA SOURCES/STUDY DESIGN: The 1999 Cohort 2 Medicare HOS baseline data were used for a cross-sectional descriptive analysis. A random sample of 1,000 beneficiaries from each health plan with a Medicare+Choice contract was surveyed (N = 156,842; 282 organizations included in these analyses) .
The HOS measure is designed to assess a previously unmeasured dimension of quality. Plan-level variation was seen across all baseline measures of sociodemographic characteristics and illness burden. At the individual level socioeconomic position as measured by educational attainment was strongly associated with functional status. The least educated beneficiaries had the highest burden of illness on all measures examined, and there was a consistent and significant gradient in health and functional status across all levels of education. In analyses stratified by race and ethnicity, socioeconomic gradients in f un ct ion persist ed. CONCLUSIONS Despite limitations, by focusing at t en t ion on the need to improve functional health out comes among elderly Medicare beneficiaries enrolled in Medicare+Choice, the HOS can serve as an important new tool to support efforts to improve health care quality. The HOS provides valuable information at the federal, state, and health plan levels that can be used to identify, prioritize, and evaluate quality improvement interventions and monitor progress for the program overall as well as for vulnerable subgroups. To interpret the HOS as a quality measure individual-and plan-level differences in functional status and illness burden, as well as methodologic issues in health status measurement, need to be recognized and addressed.
医疗保险健康结果调查（HOS）是健康计划雇主数据与信息集里一项新的质量衡量指标，旨在评估参加“医疗保险+选择”组织的医疗保险受益人的身心健康功能状况。我们结合使用该指标时在方法学上的挑战及其解读方式，讨论HOS指标的基本原理，并利用医疗保险HOS基线的描述性数据来说明其中的一些挑战。
数据来源/研究设计：1999年队列2医疗保险HOS基线数据用于横断面描述性分析。对每个拥有“医疗保险+选择”合同的健康计划中的1000名受益人进行随机抽样调查（N = 156,842；这些分析纳入了282个组织）。
HOS指标旨在评估一个此前未被衡量的质量维度。在社会人口特征和疾病负担的所有基线指标方面，各计划层面存在差异。在个体层面，以教育程度衡量的社会经济地位与功能状态密切相关。在所有考察指标中，受教育程度最低的受益人疾病负担最重，且在所有教育水平上，健康和功能状态都存在持续且显著的梯度变化。在按种族和民族分层的分析中，功能方面的社会经济梯度依然存在。结论 尽管存在局限性，但通过关注提高参加“医疗保险+选择”的老年医疗保险受益人的功能健康结果的必要性，HOS可作为一种重要的新工具，来支持改善医疗质量的努力。HOS在联邦、州和健康计划层面提供了有价值的信息，可用于识别、确定质量改进干预措施的优先级并进行评估，以及监测整个项目以及弱势群体的进展情况。要将HOS解读为一项质量指标，需要认识并解决功能状态和疾病负担在个体及计划层面的差异，以及健康状况测量中的方法学问题。
