Central Institute of Mental Health, Medical Faculty Mannheim/University Heidelberg, Square J5, 68159 Mannheim, Germany.
BMC Public Health. 2013 Jan 14;13:34. doi: 10.1186/1471-2458-13-34.
The objective of screening programs is to discover life threatening diseases in as many patients as early as possible and to increase the chance of survival. To be able to compare aspects of health care quality, methods are needed for benchmarking that allow comparisons on various health care levels (regional, national, and international).
Applications and extensions of algorithms can be used to link the information on disease phases with relative survival rates and to consolidate them in composite measures. The application of the developed SAS-macros will give results for benchmarking of health care quality. Data examples for breast cancer care are given.
A reference scale (expected, E) must be defined at a time point at which all benchmark objects (observed, O) are measured. All indices are defined as O/E, whereby the extended standardized screening-index (eSSI), the standardized case-mix-index (SCI), the work-up-index (SWI), and the treatment-index (STI) address different health care aspects. The composite measures called overall-performance evaluation (OPE) and relative overall performance indices (ROPI) link the individual indices differently for cross-sectional or longitudinal analyses.
Algorithms allow a time point and a time interval associated comparison of the benchmark objects in the indices eSSI, SCI, SWI, STI, OPE, and ROPI. Comparisons between countries, states and districts are possible. Exemplarily comparisons between two countries are made. The success of early detection and screening programs as well as clinical health care quality for breast cancer can be demonstrated while the population's background mortality is concerned.
If external quality assurance programs and benchmark objects are based on population-based and corresponding demographic data, information of disease phase and relative survival rates can be combined to indices which offer approaches for comparative analyses between benchmark objects. Conclusions on screening programs and health care quality are possible. The macros can be transferred to other diseases if a disease-specific phase scale of prognostic value (e.g. stage) exists.
筛查项目的目的是尽早发现危及生命的疾病，并尽可能提高患者的生存率。为了能够比较医疗保健质量的各个方面，需要有基准测试的方法，以便在不同的医疗保健水平（地区、国家和国际）上进行比较。
算法的应用和扩展可以将疾病阶段的信息与相对生存率联系起来，并将其整合到综合指标中。开发的 SAS 宏的应用将为医疗保健质量的基准测试提供结果。提供了乳腺癌护理的数据示例。
必须在所有基准对象（观察到的，O）都被测量的时间点定义一个参考尺度（预期，E）。所有指数都被定义为 O/E，其中扩展标准化筛查指数（eSSI）、标准化病例组合指数（SCI）、工作指数（SWI）和治疗指数（STI）分别针对不同的医疗保健方面。称为整体绩效评估（OPE）和相对整体绩效指数（ROPI）的综合指标以不同的方式链接个别指数，用于横断面或纵向分析。
算法允许在 eSSI、SCI、SWI、STI、OPE 和 ROPI 等指数中对基准对象进行与时间点和时间间隔相关的比较。可以进行国家、州和地区之间的比较。示例中比较了两个国家。可以在关注人群背景死亡率的同时，证明早期发现和筛查计划以及乳腺癌的临床医疗保健质量的成功。
如果外部质量保证计划和基准对象基于基于人群的相应人口统计数据，则可以将疾病阶段和相对生存率的信息结合到提供基准对象之间比较分析方法的指数中。可以对筛查计划和医疗保健质量得出结论。如果存在具有预后价值的疾病特异性阶段量表（例如，阶段），则可以将宏转移到其他疾病。
