Nietert Paul J, Wessell Andrea M, Jenkins Ruth G, Feifer Chris, Nemeth Lynne S, Ornstein Steven M
Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC, USA.
Implement Sci. 2007 Apr 2;2:11. doi: 10.1186/1748-5908-2-11.
Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID) in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR). All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States.
The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI) project.
At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p < 0.0001) increases during a major QI initiative, and its internal consistency is excellent (Cronbach's alpha = 0.93). Feedback from physicians has been extremely positive, providing a high degree of face validity.
The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers.
评估初级保健质量正成为国家医疗保健议程中的一项优先事项。对医疗质量绩效指标进行审核和反馈有助于提高所提供的医疗服务质量。在某些情况下，较少数量但更全面的指标可能更可取。本文描述了在使用电子病历（EMR）的患者和初级保健机构中，使用汇总质量指数（SQUID）来跟踪医疗质量的情况。所有机构都是实践伙伴研究网络的一部分，代表了美国各地100多个门诊医疗机构。
SQUID由36项过程和结果指标组成，所有这些指标均从EMR中获取。本文描述了SQUID计算的算法、各种统计特性，以及在多机构质量改进（QI）项目背景下SQUID的使用情况。
在任何给定时间点，患者层面的SQUID反映了所接受的推荐治疗的比例，而机构层面的SQUID反映了该机构患者所接受的推荐治疗的平均比例。通过季度报告，定期向网络内的机构提供机构层面和患者层面的SQUID。SQUID具有响应性，在一项重大QI倡议期间呈现出高度显著（p < 0.0001）的增长，其内部一致性极佳（Cronbach's alpha = 0.93）。医生的反馈非常积极，具有很高的表面效度。
SQUID算法可行且简单，提供了一个有用的QI工具。其统计特性和清晰的解释使其对提供者、健康计划和研究人员具有吸引力。
