Pillittere-Dugan Donna, Nau David P, McDonough Kimberly, Pierre Zakiya
Performance Measurement, National Committee for Quality Assurance, Washington, DC, USA.
J Am Pharm Assoc (2003). 2009 Mar-Apr;49(2):212-9. doi: 10.1331/JAPhA.2009.09012.
To report on the status of the pilot work of PQA, a pharmacy quality alliance, to develop and test performance metrics of pharmacy services for use in quality improvement, benchmarking, and pay-for-performance benchmarks.
Observational cohort study.
Three health plans (commercial, Medicare and Medicaid) located in the northeastern United States and one nationwide prescription drug plan.
Pharmacies of health plans with membership ranging from approximately 3,330 to nearly 1.7 million members.
Pharmaceutical claims data for prescriptions dispensed at community pharmacies were analyzed.
Not applicable.
The four plans had pharmacy networks ranging from 653 to 53,153 pharmacies. When using a minimum sample of 30 members per measure, less than 10% of the pharmacies within the plans' networks were evaluable for all measures except the measure of high-risk drugs in the elderly. The measure for high-risk drugs in the elderly had 6,210 evaluable pharmacies in a network of 53,153. The measures for high-risk drugs in the elderly and medication adherence appear to have the greatest potential for use as performance measures in that they show room for improvement and variation among pharmacies.
The ideal performance measure is relevant, scientifically sound, and feasible. Several of the measures that underwent testing possessed some, if not all, of the properties of an ideal performance measure. Strategies for aggregating data across health and drug plans may be useful for overcoming sample size challenges.
报告药学质量联盟（PQA）开展试点工作的情况，该联盟旨在制定并测试药学服务绩效指标，以用于质量改进、基准比较和绩效薪酬基准设定。
观察性队列研究。
位于美国东北部的三个健康计划（商业保险、医疗保险和医疗补助）以及一个全国性处方药计划。
健康计划中的药房，会员人数从约3330人到近170万人不等。
分析社区药房所配处方的药品报销数据。
不适用。
这四个计划的药房网络包含653至53153家药房。当每项指标使用至少30名会员的最小样本量时，除老年人高风险药物指标外，计划网络内不到10%的药房可对所有指标进行评估。在一个包含53153家药房的网络中，老年人高风险药物指标有6210家可评估药房。老年人高风险药物指标和用药依从性指标似乎最有潜力用作绩效指标，因为它们显示出药房之间存在改进空间和差异。
理想的绩效指标应相关、科学合理且可行。经过测试的一些指标具备理想绩效指标的部分（即便不是全部）特性。跨健康和药品计划汇总数据的策略可能有助于克服样本量挑战。
