Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Implement Sci. 2010 Feb 9;5:13. doi: 10.1186/1748-5908-5-13.
The measurement of healthcare provider performance is becoming more widespread. Physicians have been guarded about performance measurement, in part because the methodology for comparative measurement of care quality is underdeveloped. Comprehensive quality improvement will require comprehensive measurement, implying the aggregation of multiple quality metrics into composite indicators.
To present a conceptual framework to develop comprehensive, robust, and transparent composite indicators of pediatric care quality, and to highlight aspects specific to quality measurement in children.
We reviewed the scientific literature on composite indicator development, health systems, and quality measurement in the pediatric healthcare setting. Frameworks were selected for explicitness and applicability to a hospital-based measurement system.
We synthesized various frameworks into a comprehensive model for the development of composite indicators of quality of care. Among its key premises, the model proposes identifying structural, process, and outcome metrics for each of the Institute of Medicine's six domains of quality (safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity) and presents a step-by-step framework for embedding the quality of care measurement model into composite indicator development.
The framework presented offers researchers an explicit path to composite indicator development. Without a scientifically robust and comprehensive approach to measurement of the quality of healthcare, performance measurement will ultimately fail to achieve its quality improvement goals.
医疗服务提供者的绩效衡量正变得越来越普遍。由于医疗质量的比较衡量方法尚不成熟，医生对绩效衡量持谨慎态度。全面的质量改进需要全面的衡量，这意味着将多个质量指标综合为综合指标。
提出一个概念框架，以开发全面、稳健和透明的儿科护理质量综合指标，并强调儿童质量衡量的特定方面。
我们回顾了关于综合指标制定、卫生系统以及儿科医疗保健环境中质量衡量的科学文献。选择了框架以明确性和对基于医院的衡量系统的适用性。
我们将各种框架综合为一个全面的护理质量综合指标制定模型。该模型的主要前提包括为医学研究所的六个质量领域（安全性、有效性、效率、以患者为中心、及时性和公平性）中的每一个确定结构、过程和结果指标，并提出了一个将护理质量衡量模型嵌入综合指标制定的逐步框架。
所提出的框架为研究人员提供了一个明确的综合指标制定路径。如果没有对医疗保健质量进行科学稳健和全面的衡量方法，绩效衡量最终将无法实现其质量改进目标。
