养老院质量指标的调整。
Adjustment of nursing home quality indicators.
机构信息
Institute for Aging Research, Hebrew SeniorLife, Boston MA, USA.
出版信息
BMC Health Serv Res. 2010 Apr 15;10:96. doi: 10.1186/1472-6963-10-96.
BACKGROUND
This manuscript describes a method for adjustment of nursing home quality indicators (QIs) defined using the Center for Medicaid & Medicare Services (CMS) nursing home resident assessment system, the Minimum Data Set (MDS). QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presumed quality of care include baseline resident health and functional status, pattern of comorbidities, and facility case mix. The goal of obtaining a valid facility-level estimate of true quality of care should include adjustment for resident- and facility-level sources of variability.
METHODS
We present a practical and efficient method to achieve risk adjustment using restriction and indirect and direct standardization. We present information on validity by comparing QIs estimated with the new algorithm to one currently used by CMS.
RESULTS
More than half of the new QIs achieved a "Moderate" validation level.
CONCLUSIONS
Given the comprehensive approach and the positive findings to date, research using the new quality indicators is warranted to provide further evidence of their validity and utility and to encourage their use in quality improvement activities.
背景
本文描述了一种使用医疗保险和医疗补助服务中心（CMS）疗养院居民评估系统（MDS）定义的疗养院质量指标（QIs）的调整方法。QIs 旨在描述在设施中提供的护理质量。假定护理质量测量的有效性受到威胁，包括居民的基线健康和功能状况、合并症模式以及设施的病例组合。获得真正护理质量的有效设施水平估计的目标应包括对居民和设施水平的变异性进行调整。
方法
我们提出了一种实用且高效的风险调整方法，使用限制和间接和直接标准化。我们通过将新算法估计的 QIs 与 CMS 当前使用的一种方法进行比较，提供了有关有效性的信息。
结果
超过一半的新 QIs 达到了“中等”验证水平。
结论
鉴于全面的方法和迄今为止的积极发现，使用新的质量指标进行研究是合理的，以进一步提供其有效性和实用性的证据，并鼓励在质量改进活动中使用它们。
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