Krakauer H, Bailey R C
U.S. Public Health Service, Health Care Financing Administration, Baltimore, MD 21207.
Stat Med. 1991 Apr;10(4):521-40. doi: 10.1002/sim.4780100405.
The Health Care Financing Administration is charged by law with the assurance of the quality of the medical care rendered to Medicare beneficiaries, a function carried out through the Peer Review Organizations. To guide and support this activity, a programme of epidemiologic surveillance of the health of such persons has been devised and is being implemented. Its focus is on the objective measures of health-mortality, morbidity, disability and expenditures for health care. Its principal components are analyses of trends in those measures over time and of their variations among geographic areas, as problem-finding techniques, and evaluations of the comparative effectiveness of strategies of management of patients, as problem-solving tools. Examples of the feasibility and utility of this strategy include an evaluation of the longitudinal impact of administrative changes undertaken in 1983-1984, the assessment of variations in patient mortality rates among hospitals, the characterization of the management of patients with ischemic heart disease, and a demonstration of a methodology for the observational evaluation of revascularization in various types of patients hospitalized for acute myocardial infarction. The objectives of the programme are the improvement of review of medical practices as carried out by the Peer Review Organizations, assistance to clinicians in the management of patients, and guidance to planners in the allocation of resources.
医疗保健财务管理局依法负责确保向医疗保险受益人提供的医疗服务质量，这一职能通过同行评审组织来履行。为指导和支持这一活动，已制定并正在实施一项针对此类人群健康状况的流行病学监测计划。其重点在于对健康状况的客观衡量指标——死亡率、发病率、残疾率以及医疗保健支出。其主要组成部分包括：作为问题发现技术，分析这些指标随时间的变化趋势以及它们在不同地理区域的差异；作为问题解决工具，评估患者管理策略的相对有效性。该策略的可行性和实用性的例子包括：对1983 - 1984年行政变革的纵向影响进行评估、对医院间患者死亡率差异进行评估、对缺血性心脏病患者的管理特征进行描述，以及展示一种针对因急性心肌梗死住院的各类患者进行血管重建观察性评估的方法。该计划的目标是改进同行评审组织对医疗实践的审查、协助临床医生进行患者管理以及为资源分配规划者提供指导。
