Kerr Eve A, Hofer Timothy P, Hayward Rodney A, Adams John L, Hogan Mary M, McGlynn Elizabeth A, Asch Steven M
Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Health Serv Res. 2007 Oct;42(5):2070-87. doi: 10.1111/j.1475-6773.2007.00730.x.
Many performance measurement systems are designed to identify differences in the quality provided by health plans or facilities. However, we know little about whether different methods of performance measurement provide similar answers about the quality of care of health care organizations. To examine this question, we used three different measurement approaches to assess quality of care delivered in veteran affairs (VA) facilities.
DATA SOURCES/STUDY SETTING: Medical records for 621 patients at 26 facilities in two VA regions.
We examined agreements in quality conclusions using: focused explicit (38 measures for six conditions/prevention), global explicit (372 measures for 26 conditions/prevention), and structured implicit review physician-rated care (a single global rating of care for three chronic conditions and overall acute, chronic and preventive care). Trained nurse abstractors and physicians reviewed all medical records. Correlations between scores from the three systems were adjusted for measurement error in each using multilevel regression models.
Intercorrelations of scores were generally moderate to high across all three systems, and rose with adjustment for measurement error. Site-level correlations for prevention and diabetes care were particularly high. For example, adjusted for measurement error at the site level, prevention quality was correlated at 0.89 between the implicit and global systems, 0.67 between implicit and focused, and 0.73 between global and focused systems.
We found moderate to high agreement in quality scores across the three profiling systems for most clinical areas, indicating that all three were measuring a similar construct called "quality." Adjusting for measurement error substantially enhanced our ability to identify this underlying construct.
许多绩效评估系统旨在识别健康计划或机构所提供服务质量的差异。然而，对于不同的绩效评估方法是否能就医疗保健组织的医疗质量给出相似答案，我们知之甚少。为研究这个问题，我们采用了三种不同的评估方法来评估退伍军人事务（VA）机构提供的医疗质量。
数据来源/研究背景：来自两个VA地区26个机构的621名患者的病历。
我们使用以下方法来检验质量结论的一致性：聚焦明确法（针对六种疾病/预防措施的38项指标）、全局明确法（针对26种疾病/预防措施的372项指标）以及结构化隐式审查医生评定护理法（对三种慢性病以及总体急性、慢性和预防性护理的单一全局护理评定）。经过培训的护士摘要员和医生审查了所有病历。使用多级回归模型对每个系统得分之间的相关性进行测量误差调整。
在所有三个系统中，得分的相互关联性总体上为中等至高，并且在进行测量误差调整后有所上升。预防和糖尿病护理方面的机构层面相关性尤其高。例如，在机构层面进行测量误差调整后，隐式和全局系统之间的预防质量相关性为0.89，隐式和聚焦系统之间为0.67，全局和聚焦系统之间为0.73。
我们发现，在大多数临床领域，这三种剖析系统的质量得分具有中等至高的一致性，表明这三种系统都在测量一个类似的概念，即“质量”。对测量误差进行调整显著增强了我们识别这一潜在概念的能力。
