Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
J Am Geriatr Soc. 2015 Aug;63(8):1601-7. doi: 10.1111/jgs.13560. Epub 2015 Jul 22.
To describe variations in potentially inappropriate prescribing (PIP) and characterize the extent to which switching to an incidence-based indicator would affect health system quality rankings.
Observational study.
Veterans Health Administration in 2011.
Older adults receiving outpatient primary care.
PIP was defined according to the National Committee for Quality Assurance High-Risk Medications in the Elderly list. Ranks were separately assigned for prevalent and incident PIP at the regional, network, and healthcare system levels.
National PIP prevalence was 12.3% (167,766/1,360,251), and incidence was 5.8% (78,604/1,360,251). PIP prevalence ranged from 3.5% to 33.1% across healthcare systems (interquartile range (IQR) = 9.2-15.5%). PIP incidence ranged from 1.2% to 14.9% (IQR = 4.1-7.2%). Rank order in PIP prevalence and incidence was correlated (Spearman correlation; ρ = 0.934, P < .001), although substantial changes in ranks were seen for some healthcare systems, with seven of 139 (5.0%) systems shifting more than 30 rank positions and 21 (15.1%) systems shifting 16 to 30 positions.
Prevalence- and incidence-based indicators of prescribing quality were strongly correlated. Transitioning to incidence-based indicators would not produce an initial disruption in quality rankings for most healthcare systems and might yield more-salient measures for tracking healthcare quality.
描述潜在不适当处方（PIP）的变化，并描述采用基于发生率的指标将如何影响卫生系统质量排名。
观察性研究。
2011 年退伍军人健康管理局。
接受门诊初级保健的老年人。
根据国家质量保证委员会老年人高风险药物清单定义 PIP。分别为区域、网络和医疗保健系统各级的现患和新发 PIP 分配排名。
全国 PIP 患病率为 12.3%（167766/1360251），发生率为 5.8%（78604/1360251）。PIP 患病率在医疗保健系统之间的差异为 3.5%至 33.1%（四分位间距（IQR）=9.2-15.5%）。PIP 发生率从 1.2%到 14.9%（IQR=4.1-7.2%）。PIP 患病率和发生率的排名顺序相关（Spearman 相关；ρ=0.934，P<.001），尽管一些医疗保健系统的排名发生了实质性变化，139 个系统中有 7 个（5.0%）系统的排名变化超过 30 位，21 个（15.1%）系统的排名变化为 16 至 30 位。
基于患病率和发生率的处方质量指标密切相关。向基于发生率的指标过渡不会对大多数医疗保健系统的初始质量排名产生干扰，并且可能为跟踪医疗保健质量提供更显著的措施。
