Schneider Eric C, Nadel Marion R, Zaslavsky Alan M, McGlynn Elizabeth A
Department of Health Policy and Management, Harvard School of Public Health, and Division of General Medicine, Brigham and Women's Hospital, 677 Huntington Ave, Room 406, Boston, Massachusetts 02115, USA.
Arch Intern Med. 2008 Apr 28;168(8):876-82. doi: 10.1001/archinte.168.8.876.
Relatively few studies have evaluated the scientific soundness of widely used performance measures. This study evaluated quality measures by describing a field test of the colorectal cancer screening measure included in the Health Plan Employer Data and Information Set of the National Committee for Quality Assurance.
We conducted a field test in 5 health care plans that enrolled 189 193 individuals considered eligible for colorectal cancer screening. We assessed measurement bias by calculating the prevalence of colorectal cancer screening while varying the data sources used (administrative data only, a hybrid of administrative data and medical record data, and enrollee survey data only) and the minimum required enrollment period (2-10 years).
Across the 5 health care plans, the percentage of health care plan enrollees counted as screened varied according to the data used, ranging from 27.3% to 47.1% with the administrative data, 38.6% to 53.5% with the hybrid data, and 53.2% to 69.7% with the survey data. The relative ranking of plans also varied. One health care plan ranked first based on administrative data, second based on hybrid data, and fourth based on survey data. Survey respondents were more likely than nonrespondents to have evidence of colorectal cancer screening (62.7% vs 46.5%; P < .001).
Administrative data seem to underestimate colorectal cancer screening and survey data seem to overestimate it, suggesting that a hybrid data approach offers the most accurate measure of screening. Implementation of performance measures should include evaluation of their scientific soundness.
相对较少的研究评估了广泛使用的绩效指标的科学合理性。本研究通过描述对美国国家质量保证委员会健康计划雇主数据与信息集（Health Plan Employer Data and Information Set）中包含的结直肠癌筛查指标进行的现场测试，来评估质量指标。
我们在5个医疗保健计划中进行了现场测试，这些计划纳入了189193名被认为符合结直肠癌筛查条件的个体。我们通过计算结直肠癌筛查的患病率来评估测量偏差，同时改变所使用的数据来源（仅行政数据、行政数据与病历数据的混合数据以及仅参保人调查数据）和最低所需参保期限（2至10年）。
在这5个医疗保健计划中，被计为已筛查的医疗保健计划参保人的百分比因所使用的数据而异，仅行政数据时为27.3%至47.1%，混合数据时为38.6%至53.5%，调查数据时为53.2%至69.7%。各计划的相对排名也有所不同。一个医疗保健计划基于行政数据排名第一，基于混合数据排名第二，基于调查数据排名第四。与未回应者相比，回应调查者更有可能有结直肠癌筛查的证据（62.7%对46.5%；P <.001）。
行政数据似乎低估了结直肠癌筛查情况，而调查数据似乎高估了它，这表明混合数据方法提供了最准确的筛查测量。绩效指标的实施应包括对其科学合理性的评估。
