Rose Johnie
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA.
Qual Manag Health Care. 2008 Jan-Mar;17(1):27-34. doi: 10.1097/01.QMH.0000308635.59108.29.
With the impact of pay for performance likely to broaden and deepen in the coming years, ensuring that the quality measures used in these initiatives are based on the best possible clinical evidence and expert consensus is paramount. Two types of organizations greatly influence the content of quality measures: measure development organizations-such as the National Committee for Quality Assurance-and medical professional societies. The process by which emerging measures of quality are created is subject to bias resulting from organizational and individual conflicts of interest in both types of organizations. This article examines the financial ties between those who-both directly and indirectly-help create the standards used in pay-for-performance programs and those firms whose revenues will increasingly depend on the substance of these measures. Several examples of inappropriate industry influence in the drafting of clinical practice guidelines by professional societies illustrate that these groups' future management of conflicts of interest may ultimately affect the success of pay-for-performance programs. Finally, policy options for minimizing the effects of these conflicts on the development of quality measures are discussed.
随着绩效薪酬的影响在未来几年可能会扩大和加深，确保这些举措中使用的质量衡量标准基于尽可能最佳的临床证据和专家共识至关重要。有两类组织对质量衡量标准的内容有很大影响：衡量标准制定组织——如国家质量保证委员会——以及医学专业协会。新出现的质量衡量标准的创建过程容易受到这两类组织中组织和个人利益冲突所导致的偏见影响。本文研究了那些直接和间接帮助制定绩效薪酬计划所使用标准的人员与那些收入将越来越依赖于这些衡量标准实质内容的公司之间的财务关系。专业协会在起草临床实践指南时受到行业不当影响的几个例子表明，这些团体未来对利益冲突的管理可能最终影响绩效薪酬计划的成功。最后，讨论了将这些冲突对质量衡量标准制定的影响降至最低的政策选择。
