Michael E. DeBakey VA Medical Center Baylor College of Medicine, Houston, TX 77030, USA.
Med Care. 2011 Oct;49(10):883-90. doi: 10.1097/MLR.0b013e318222a36c.
Measurement of hospitals' clinical performance is becoming more ubiquitous in an effort to inform patient choices, payer reimbursement decisions, and quality improvement initiatives such as pay-for-performance. As more measures are developed, the intensity with which measures are monitored changes. Performance measures are often retired after a period of sustained performance and not monitored as actively as other measures where performance is more variable. The effect of actively versus passively monitoring performance on measured quality of care is not known.
We compared the nature and rate of change in hospital outpatient clinical performance as a function of a measure's status (active vs. passive), and examined the mean time to stability of performance after changing status. We hypothesize that performance will be higher when measures are actively monitored than when they are passively monitored.
Longitudinal, hierarchical retrospective analyses of outpatient clinical performance measure data from Veterans Health Administration's External Peer Review Program from 2000 to 2008.
One hundred thirty-three Veterans Health Administration Medical Centers throughout the United States and its associated territories.
Clinical performance on 17 measures covering 5 clinical areas common to ambulatory care: screening, immunization, chronic care after acute myocardial infarction, diabetes mellitus, and hypertension.
Contrary to expectations, we found that measure status (whether active or passive) did not significantly impact performance over time; time to stability of performance varied considerably by measure, and did not seem to covary with performance at the stability point (ie, performance scores for measures with short stability times were no higher or lower than scores for measures with longer stability times).
We found no significant "extinction" of performance after measures were retired, suggesting that other features of the health care system, such as organizational policies and procedures or other structural features, may be creating a "strong situation" and sustaining performance. Future research should aim to better understand the effects of monitoring performance using process-of-care measures and creating sustained high performance.
为了向患者选择、支付方报销决策以及绩效付费等质量改进措施提供信息，医院临床绩效的衡量正变得越来越普遍。随着越来越多的衡量标准的制定，衡量标准的监测强度也在发生变化。在一段时间的持续表现后，绩效衡量标准通常会被淘汰，并且不会像其他绩效变化更大的衡量标准那样被积极监测。积极监测与被动监测绩效对所衡量的护理质量的影响尚不清楚。
我们比较了衡量标准（主动监测与被动监测）状态对医院门诊临床绩效的性质和变化率的影响，并研究了改变状态后绩效达到稳定所需的平均时间。我们假设，与被动监测相比，积极监测衡量标准时，绩效会更高。
对 2000 年至 2008 年退伍军人健康管理局外部同行审查计划的门诊临床绩效衡量标准数据进行的纵向、分层回顾性分析。
美国 133 个退伍军人健康管理局医疗中心和相关地区。
涵盖门诊护理常见的 5 个临床领域（筛查、免疫接种、急性心肌梗死后慢性护理、糖尿病和高血压）的 17 项临床绩效衡量标准。
与预期相反，我们发现衡量标准状态（主动或被动）并不会随时间显著影响绩效；绩效达到稳定的时间因衡量标准而异，并且似乎与稳定点的绩效无关（即，稳定时间较短的衡量标准的绩效得分并不高于稳定时间较长的衡量标准的得分）。
我们发现，在衡量标准淘汰后，绩效并没有明显“消失”，这表明医疗保健系统的其他特征，如组织政策和程序或其他结构特征，可能正在创造一种“强情境”并维持绩效。未来的研究应旨在更好地了解使用护理过程衡量标准和创造持续高绩效来监测绩效的影响。
