Giard R W M
Medisch Centrum Rijnmond-Zuid, locatie Clara, afd. Klinische Pathologie, Postbus 9119, 3007 AC Rotterdam.
Ned Tijdschr Geneeskd. 2005 Dec 3;149(49):2715-9.
Performance indicators may provide an indication of insufficient quality of medical care but they do not identify the cause of the problem. The political context for performance indicators is based on market ideology, where quality improvement is the goal and consumer pressure is the means. It is usually difficult to compare performance indicators among hospitals given the differences in definitions, methods of assessment, case mix, preclinical factors and data quality. Performance indicators are risk assessments and therefore subject to chance variation. Conclusions regarding performance indicators cannot be drawn due to the lack of clear, predefined benchmarks. At this time, the presence and degree of consumer pressure is unclear, and the ultimate effects of making performance factors publicly available on the quality of care is unknown. The question is whether mandatory reporting of a set of performance indicators by hospitals can provide sufficient insight into the quality of care; the measure appears to be too rough and too many factors influence the outcome. Procedure assessment is a good alternative to the use of performance indicators.
绩效指标可能表明医疗服务质量不足，但它们无法确定问题的原因。绩效指标的政治背景基于市场意识形态，其目标是提高质量，手段是消费者压力。鉴于定义、评估方法、病例组合、临床前因素和数据质量存在差异，通常很难在医院之间比较绩效指标。绩效指标是风险评估，因此会受到随机变化的影响。由于缺乏明确的、预先定义的基准，无法得出关于绩效指标的结论。目前，消费者压力的存在和程度尚不清楚，公开绩效因素对医疗质量的最终影响也未知。问题在于医院强制报告一组绩效指标是否能充分洞察医疗质量；这种措施似乎过于粗略，而且有太多因素影响结果。程序评估是使用绩效指标的一个很好的替代方法。
