Center for Health Equity Research and Promotion, Philadelphia, USA.
Health Serv Res. 2008 Oct;43(5 Pt 1):1464-84. doi: 10.1111/j.1475-6773.2007.00817.x. Epub 2007 Dec 20.
Quality measures may be associated with improved outcomes for two reasons. First, measured activities may directly improve care. Second, success on these measures may be a marker for other unmeasured aspects of high quality care. Our objective is to test the contribution of both possible effects.
2004 Medicare data on hospital performance from Hospital Compare and risk-adjusted mortality rates from Medicare Part A claims.
We studied 3,657 acute care U.S. hospitals and compared observed differences in condition-specific hospital mortality rates based on hospital performance with expected differences in mortality from the clinical studies underlying the measures.
Differences in observed mortality rates across U.S. hospitals are larger than what would be expected if these differences were due only to the direct effects of delivering measured care.
Performance measures reflect care processes that both improve care directly and are also markers of elements of health care quality that are otherwise unmeasured. This finding suggests that process measures capture important information about care that is not directly measured, and that these unmeasured effects are in general larger than the measured effects.
质量指标可能与改善结果相关，原因有二。首先，所衡量的活动可能直接改善医疗服务。其次，在这些指标上取得成功可能是其他未被衡量的高质量医疗服务方面的标志。我们的目标是检验这两种可能的效果的贡献。
2004 年来自医院比较（Hospital Compare）的医疗保险数据和医疗保险 A 部分索赔的风险调整死亡率。
我们研究了 3657 家美国急性护理医院，并根据医院绩效观察到的特定疾病的医院死亡率差异与这些措施所依据的临床研究中的死亡率预期差异进行了比较。
美国医院之间的死亡率差异大于仅归因于提供所衡量的护理的直接效果的情况下所预期的差异。
绩效指标反映了直接改善医疗服务的护理流程，并且也是其他未被衡量的医疗质量要素的标志。这一发现表明，过程指标捕捉了关于护理的重要信息，这些信息未被直接衡量，而且这些未被衡量的效果通常大于被衡量的效果。
