School of Health and Human Sciences, Southern Cross University, East Lismore, NSW, Australia.
J Multidiscip Healthc. 2013;6:1-16. doi: 10.2147/JMDH.S37727. Epub 2013 Jan 7.
For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian's structure-process-outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the project.
十多年来，各组织一直试图在资助者和医疗服务提供者之间的合同中纳入健康结果数据的测量和报告，但收效甚微。本研究探讨了在澳大利亚社区护理组织（CCO）的资金合同中纳入健康结果数据的实用性。采用行动研究方法，在 CCO 内的六个不同项目中试用了基于国际功能分类的干预措施分类法来进行结果测量。六个项目的结果以情景为例呈现，说明了在每种情况下常规收集健康结果的问题。数据收集和分析围绕着 Donabedian 的结构-过程-结果三角结构进行。健康结果通常被定义为归因于干预的健康状况的变化。这个定义假设健康状况的变化可以被定义和客观地测量；干预可以被定义；健康状况的变化归因于干预；并且健康结果数据是可获得的。本研究发现，这些假设都存在缺陷，严重削弱了社区组织引入常规健康结果测量的能力。在 Donabedian 三角的所有阶段都发现了挑战，包括对最小数据集要求的遵守情况不佳；难以使过程标准化或定义干预措施；结果工具的使用率低；工具对服务提供者的价值低；定义或确定干预终点的困难；获取数据的技术和道德障碍；缺乏标准化流程；以及数据收集的时间滞后。在任何情况下，都没有任何一个团队能够持续使用结果测量方法，尽管项目引入了一些质量保证措施。
