Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
J Health Serv Res Policy. 2011 Jul;16 Suppl 2:38-47. doi: 10.1258/jhsrp.2011.011042.
Measuring quality of care through performance indicators and subsequently using these to compare, learn, and improve (benchmarking) has become a central component of health care policy. This paper aims to identify the main themes of health services research in this area and focuses on opportunities for improving the evidence underpinning performance indicators.
A literature survey was carried out to identify research activities and main research themes in Europe in the years 2000-09. Identified literature was categorized into sub-topics and for each topic the main methodological issues were identified and discussed. Experts validated the findings and explored the potential for related further European research.
The distribution of research on performance and benchmarking across EU member states varies in time, scope and settings with a large amount of studies focusing on hospitals. Eight specific fields of research were identified (research on concepts and performance frameworks; performance indicators and benchmarking using mortality data; performance indicators and benchmarking related to cancer care; performance indicators and benchmarking on care delivered in hospitals; patient safety indicators; performance indicators in primary care; patient experience; research on the practice of benchmarking and performance improvement). Expert discussions confirmed that research on performance indicators and benchmarking should focus on the development of indicators, as well as their use. The research should involve the potential users and incorporate scientific approaches from biomedicine and epidemiology as well as the social sciences. Further progress is hampered by data availability. Issues which need to be addressed include the use of unique patient identifiers (UPIs) to facilitate linkages between separate databases; standardized measurement of the experiences of patients and others; and deepening collaboration between Eurostat, the World Health Organization (WHO), and the Organization for Economic Co-operation and Development (OECD) to facilitate the availability of internationally comparable performance information.
This study suggests a number of themes for future research. These include testing and improving: the validity and reliability of performance indicators, especially related to avoidable mortality and other outcome indicators; the effectiveness and efficiency of embedding performance indicators in the various governance, monitoring and management models, and their effect on health systems, services and professionals; and the effectiveness and efficiency of linking performance indicators to other national and international strategies and policies such as accreditation and certification, practice guidelines, audits, quality systems, patient safety strategies, national standards on volume and/or quality, public reporting, pay-for-performance and patient/consumer involvement. The field would benefit from strengthening the clearinghouse function for research findings, training of researchers and appropriate scientific publication media. Results should be systematically shared with policy-makers and managers, and networking stimulated between the growing number of regional and national institutes involved in quality measurement and reporting.
通过绩效指标衡量医疗质量，并随后利用这些指标进行比较、学习和改进（基准测试），已成为医疗保健政策的核心组成部分。本文旨在确定该领域卫生服务研究的主要主题，并重点探讨如何改进绩效指标的证据基础。
开展文献调查，以确定 2000 年至 2009 年期间欧洲的研究活动和主要研究主题。将已确定的文献归入子主题，并为每个主题确定和讨论主要方法问题。专家对调查结果进行了验证，并探讨了在相关领域进一步开展欧洲研究的可能性。
欧盟成员国之间在绩效和基准测试方面的研究分布在时间、范围和环境方面存在差异，大量研究集中在医院。确定了 8 个具体的研究领域（概念和绩效框架研究；使用死亡率数据进行绩效指标和基准测试；癌症护理相关的绩效指标和基准测试；医院提供的护理的绩效指标和基准测试；患者安全指标；初级保健绩效指标；患者体验；基准测试和绩效改进实践研究）。专家讨论证实，绩效指标和基准测试的研究应侧重于指标的制定及其使用。研究应涉及潜在用户，并结合生物医学和流行病学以及社会科学的科学方法。进一步的进展受到数据可用性的限制。需要解决的问题包括使用唯一患者标识符（UPI）促进单独数据库之间的链接；标准化测量患者和其他人的体验；深化欧盟统计局、世界卫生组织（世卫组织）和经济合作与发展组织（经合组织）之间的合作，以促进提供具有国际可比性的绩效信息。
本研究提出了一些未来研究的主题。这些主题包括测试和改进：绩效指标的有效性和可靠性，特别是与可避免死亡率和其他结果指标相关的指标；将绩效指标嵌入各种治理、监测和管理模型中的有效性和效率，以及它们对卫生系统、服务和专业人员的影响；将绩效指标与其他国家和国际战略和政策（如认证和认证、实践指南、审计、质量体系、患者安全策略、数量和/或质量国家标准、公开报告、按绩效付费和患者/消费者参与）联系起来的有效性和效率。该领域将受益于加强研究结果的信息交换中心功能、研究人员培训和适当的科学出版媒体。应将研究结果系统地与决策者和管理者共享，并在越来越多参与质量衡量和报告的区域和国家机构之间促进网络建设。
