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雇主了解他们提供的医疗保健福利的质量吗?使用 HEDIS 抑郁评分来评估健康计划。

Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

出版信息

Psychiatr Serv. 2013 Nov 1;64(11):1134-9. doi: 10.1176/appi.ps.201200534.

Abstract

OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

摘要

目的

传播医疗质量指标是利用市场力量(如雇主基于价值的采购)来提高医疗质量的必要组成部分。本研究考察了向有兴趣改善抑郁治疗的公司报告医疗保健效果数据和信息集(HEDIS)抑郁措施的情况。

方法

在 2009 年至 2011 年期间进行的调查中,对 325 家有兴趣改善抑郁治疗的雇主进行了抽样调查,询问他们的主要医疗计划是否向全国质量保证委员会(NCQA)报告 HEDIS 抑郁评分,如果是,他们是否知道这些评分。健康计划的 HEDIS 报告数据是从 NCQA 收集的。

结果

154 家(47%)雇主的主要医疗计划报告了 HEDIS 抑郁评分,但只有 7%的雇主知道他们计划的 HEDIS 评分。由于较大的雇主更有可能报告知道这些分数,因此所有员工中有 53%的员工在报告知道分数的雇主处工作。一些结构、健康福利和需求特征预测了雇主对 HEDIS 抑郁评分的了解程度。

结论

研究表明,即使其计划公开报告,有积极性的雇主也不知道他们的抑郁 HEDIS 评分。医疗保健质量措施并未到达保险产品的购买者;然而,较大的雇主更有可能知道他们健康计划的 HEDIS 评分,这表明基于价值的采购可能有一定能力影响医疗保健质量。

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