Gerteis Margaret, Peikes Deborah, Ghosh Arkadipta, Timmins Lori, OʼMalley Ann S, Barna Michael, Taylor Erin F, Day Timothy J, Swankoski Kaylyn, Payne Perry W, Brown Randall
J Healthc Qual. 2018 Jul/Aug;40(4):187-193. doi: 10.1097/JHQ.0000000000000099.
Performance feedback is central to data-driven models of quality improvement, but the use of claims-based data for feedback has received little attention.
To examine the challenges, uses, and limitations of quarterly Medicare claims-based performance feedback reports generated for practices participating in the Comprehensive Primary Care (CPC) initiative from 2012 to 2015.
Mixed methods study of nearly 500 CPC practices in seven regions, combining pilot testing; systematic monitoring; surveys; in-depth interviews; user feedback; and input from data feedback team.
Designing reports required addressing issues about timing, data completeness and reliability, variations in patient risk across practices, and use of benchmarks and metrics understandable to users. Practices' ability to use reports constructively depended on their experience, analytic resources, expectations, and perceptions about the role of primary care in improving reported outcomes.
Generating claims-based feedback reports that support practices' quality improvement efforts requires a significant investment of analytic expertise, time, resources, continuous improvement, and technical assistance.
Claims-based performance feedback can provide insight into patterns of patients' care across provider settings and opportunities for improvement, but practices need data from other sources to manage patients in real time or assess the short-term effects of specific changes in care delivery.
绩效反馈是数据驱动的质量改进模型的核心，但基于索赔数据进行反馈的应用很少受到关注。
探讨2012年至2015年为参与综合初级保健（CPC）倡议的医疗机构生成的季度医疗保险基于索赔的绩效反馈报告的挑战、用途和局限性。
对七个地区近500家CPC医疗机构进行混合方法研究，结合试点测试、系统监测、调查、深入访谈、用户反馈以及数据反馈团队的意见。
设计报告需要解决有关时间安排、数据完整性和可靠性、各医疗机构患者风险差异以及使用用户可理解的基准和指标等问题。医疗机构建设性地使用报告的能力取决于其经验、分析资源、期望以及对初级保健在改善报告结果中作用的认知。
生成支持医疗机构质量改进工作的基于索赔的反馈报告需要投入大量的分析专业知识、时间、资源、持续改进以及技术援助。
基于索赔的绩效反馈可以洞察不同医疗机构的患者护理模式以及改进机会，但医疗机构需要来自其他来源的数据来实时管理患者或评估护理提供方面特定变化的短期影响。
