Weiner J P, Powe N R, Steinwachs D M, Dent G
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
QRB Qual Rev Bull. 1990 Dec;16(12):424-38. doi: 10.1016/s0097-5990(16)30404-3.
Insurance claims records, which document many aspects of the process and outcome of medical care, are a practical and unobtrusive source of data for monitoring the quality of care provided to enrollees--a purpose for which they are rarely used. Data for these potential indicators could be drawn from claims or other administrative data systems. The authors established categories of care that could be used to develop claims-based indicators and compiled an annotated list of broad indicators for assessing the quality of care. The compilation of indicators is preceded by a discussion of some of the issues and challenges facing those who use and interpret claims-based indicators of quality.
保险理赔记录记录了医疗护理过程和结果的许多方面，是监测为参保人提供的护理质量的实用且不引人注意的数据来源——而它们很少被用于这一目的。这些潜在指标的数据可以从理赔记录或其他行政数据系统中获取。作者确定了可用于制定基于理赔记录的指标的护理类别，并编制了一份用于评估护理质量的广泛指标注释清单。在编制指标之前，先讨论了使用和解释基于理赔记录的质量指标的一些问题和挑战。
