Department of Medicine, General Medicine Division, University of Rochester Medical Center, Rochester, New York2Department of Public Health Sciences, Division of Healthcare Management, University of Rochester Medical Center, Rochester, New York.
JAMA. 2013 Nov 13;310(18):1971-80. doi: 10.1001/jama.2013.282047.
Measurement of health care quality and patient safety is rapidly evolving, in response to long-term needs and more recent efforts to reform the US health system around "value." Development and choice of quality measures is now guided by a national quality strategy and priorities, with a public-private partnership, the National Quality Forum, helping determine the most worthwhile measures for evaluating and rewarding quality and safety of patient care. Yet there remain a number of challenges, including diverse purposes for quality measurement, limited availability of true clinical measures leading to frequent reliance on claims data with its flaws in determining quality, fragmentation of measurement systems with redundancy and conflicting conclusions, few high-quality comprehensive measurement systems and registries, and rapid expansion of required measures with hundreds of measures straining resources. The proliferation of quality measures at the clinician, hospital, and insurer level has created challenges and logistical problems. Recommendations include raising the bar for qualtiy measurements to achieve transformational rather than incremental change in the US quality measurement system, promoting a logical set of measures for the various levels of the health system, leaving room for internal organizational improvement, harmonizing the various national and local quality measurement systems, anchoring on National Quality Forum additions and subtractions of measures to be applied, reducing reliance on and retiring claims-based measures as quickly as possible, promoting comprehensive measurement such as through registries with deep understanding of patient risk factors and outcomes, reducing attention to proprietary report cards, prompt but careful transition to measures from electronic health records, and allocation of sufficient resources to accomplish the goals of an efficient, properly focused measurement system.
医疗质量和患者安全的衡量标准正在迅速发展，以满足长期需求和最近围绕“价值”改革美国医疗体系的努力。质量措施的制定和选择现在受到国家质量战略和优先事项的指导，公私合作伙伴关系——国家质量论坛，有助于确定最有价值的衡量标准，以评估和奖励患者护理的质量和安全。然而，仍然存在许多挑战，包括质量衡量的目的多样化、真正的临床衡量标准有限，导致频繁依赖有缺陷的索赔数据来确定质量、衡量系统碎片化，存在冗余和相互矛盾的结论、高质量的综合衡量系统和登记处很少，以及需要衡量的标准迅速增加，数百项衡量标准给资源带来压力。临床医生、医院和保险公司层面的质量衡量标准的激增带来了挑战和后勤问题。建议包括提高质量衡量标准，以实现美国质量衡量系统的变革性而非渐进性变化，为医疗体系的各个层面推广一套合理的衡量标准，为内部组织改进留出空间，协调各种国家和地方质量衡量系统，以国家质量论坛的增减措施为基准，尽快减少对基于索赔的措施的依赖和退休，通过深入了解患者风险因素和结果的登记处促进全面衡量，减少对专有报告卡的关注，及时但谨慎地向电子健康记录过渡措施，并分配足够的资源来实现高效、适当重点的衡量系统的目标。
