Solon Orville, Woo Kimberly, Quimbo Stella A, Shimkhada Riti, Florentino Jhiedon, Peabody John W
University of the Philippines, School of Economics, Diliman, Philippines.
Health Policy Plan. 2009 May;24(3):167-74. doi: 10.1093/heapol/czp003. Epub 2009 Feb 18.
Measuring and monitoring health system performance is important albeit controversial. Technical, logistic and financial challenges are formidable. We introduced a system of measurement, which we call Q, to measure the quality of hospital clinical performance across a range of facilities. This paper describes how Q was developed, implemented in hospitals in the Philippines and how it compares with typical measures.
Q consists of measures of clinical performance, patient satisfaction and volume of physician services. We evaluate Q using experimental data from the Quality Improvement Demonstration Study (QIDS), a randomized policy experiment. We determined its responsiveness over time and to changes in structural measures such as staffing and supplies. We also examined the operational costs of implementing Q.
Q was sustainable, minimally disruptive and readily grafted into existing routines in 30 hospitals in 10 provinces semi-annually for a period of 2(1/2) years. We found Q to be more responsive to immediate impacts of policy change than standard structural measures. The operational costs totalled USD2133 or USD305 per assessment per site.
Q appears to be an achievable assessment tool that is a comprehensive and responsive measure of system level quality at a limited cost in resource-poor settings.
衡量和监测卫生系统绩效很重要，尽管存在争议。技术、后勤和财务方面的挑战巨大。我们引入了一种名为Q的测量系统，以衡量一系列医疗机构的医院临床绩效质量。本文描述了Q是如何开发的、在菲律宾的医院中如何实施的，以及它与典型测量方法的比较。
Q由临床绩效、患者满意度和医生服务量的测量指标组成。我们使用来自质量改进示范研究（QIDS）的实验数据来评估Q，QIDS是一项随机政策实验。我们确定了它随时间的反应性以及对人员配备和物资供应等结构指标变化的反应性。我们还研究了实施Q的运营成本。
Q具有可持续性，干扰极小，并且在两年半的时间里每半年就能轻松融入10个省份30家医院的现有常规流程中。我们发现，与标准结构指标相比，Q对政策变化的即时影响反应更灵敏。运营成本总计2133美元，即每个评估点每个地点305美元。
Q似乎是一种可行的评估工具，它能以有限的成本在资源匮乏的环境中全面且灵敏地衡量系统层面的质量。
