Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Eval Health Prof. 2010 Sep;33(3):343-64. doi: 10.1177/0163278710375695.
Previous studies using clinical performance measures suggest that quality of care for patients with multiple chronic conditions is not worse than that for others. This article presents patient-reported experiences of health care among 8,973 of chronically ill adults from eight countries, using telephone survey data. We designed a ''morbidity score'' combining the number of conditions and reported health status. Respondents with high morbidity scores reported less favorable experience with coordination of care compared to those with low morbidity scores. They also reported lower ratings of overall quality of care. There were no differences in reported experience with the individual physicians. Comparing type of comorbidity, chronic lung, and mental health problems were associated with lower ratings than hypertension, heart disease, diabetes, arthritis, and cancer. The implications and limitations of this study are discussed in the context of health care reform. Pay-for-performance programs need to account for chronic conditions to avoid penalizing physicians who care for larger shares of such patients.
先前使用临床绩效指标的研究表明，患有多种慢性病患者的护理质量并不逊于其他患者。本文使用来自八个国家的 8973 名慢性病成年患者的电话调查数据，展示了患者对医疗保健的体验。我们设计了一个“疾病负担评分”，结合了疾病数量和报告的健康状况。与低疾病负担评分者相比，高疾病负担评分者报告在医疗保健协调方面的体验较差。他们还报告了整体医疗质量的评分较低。在报告的个体医生的体验方面没有差异。与高血压、心脏病、糖尿病、关节炎和癌症相比，报告的慢性肺部和心理健康问题的患者的体验较差。在医疗改革的背景下，讨论了这项研究的意义和局限性。按绩效付费的计划需要考虑到慢性病，以避免惩罚照顾更多此类患者的医生。
