研究生医学教育质量保健临床绩效评估指标的可靠性。

The Reliability of Graduate Medical Education Quality of Care Clinical Performance Measures.

机构信息

is Assistant Professor, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science.

is the Kaiser Permanente Professor of Health Policy and Management, University of California, Berkeley School of Public Health.

出版信息

J Grad Med Educ. 2022 Jun;14(3):281-288. doi: 10.4300/JGME-D-21-00706.1. Epub 2022 Jun 13.

DOI:10.4300/JGME-D-21-00706.1

PMID:35754636

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9200256/

Abstract

BACKGROUND

Graduate medical education (GME) program leaders struggle to incorporate quality measures in the ambulatory care setting, leading to knowledge gaps on how to provide feedback to residents and programs. While nationally collected quality of care data are available, their reliability for individual resident learning and for GME program improvement is understudied.

OBJECTIVE

To examine the reliability of the Healthcare Effectiveness Data and Information Set (HEDIS) clinical performance measures in family medicine and internal medicine GME programs and to determine whether HEDIS measures can inform residents and their programs with their quality of care.

METHODS

From 2014 to 2017, we collected HEDIS measures from 566 residents in 8 family medicine and internal medicine programs under one sponsoring institution. Intraclass correlation was performed to establish patient sample sizes required for 0.70 and 0.80 reliability levels at the resident and program levels. Differences between the patient sample sizes required for reliable measurement and the actual patients cared for by residents were calculated.

RESULTS

The highest reliability levels for residents (0.88) and programs (0.98) were found for the most frequently available HEDIS measure, colorectal cancer screening. At the GME program level, 87.5% of HEDIS measures had sufficient sample sizes for reliable measurement at alpha 0.7 and 75.0% at alpha 0.8. Most resident level measurements were found to be less reliable.

CONCLUSIONS

GME programs may reliably evaluate HEDIS performance pooled at the program level, but less so at the resident level due to patient volume.

摘要

背景

住院医师规范化培训（GME）项目负责人难以将质量措施纳入门诊医疗环境中，这导致他们在如何向住院医师和项目提供反馈方面存在知识差距。虽然有全国范围内收集的医疗质量数据，但这些数据对于个体住院医师的学习和 GME 项目的改进的可靠性尚未得到充分研究。

目的

检验家庭医学和内科 GME 项目中医疗保健效果数据和信息集（HEDIS）临床绩效测量的可靠性，并确定 HEDIS 测量是否可以为住院医师及其项目提供其医疗质量信息。

方法

在 2014 年至 2017 年期间，我们从一家赞助机构下的 8 个家庭医学和内科项目中的 566 名住院医师那里收集了 HEDIS 测量数据。采用组内相关系数来确定在居民和项目层面上达到 0.70 和 0.80 可靠性水平所需的患者样本量。计算了可靠测量所需的患者样本量与住院医师实际照顾的患者数量之间的差异。

结果

在居民（0.88）和项目（0.98）方面，HEDIS 最常用的测量指标（结直肠癌筛查）具有最高的可靠性水平。在 GME 项目层面上，87.5%的 HEDIS 测量指标在 alpha 0.7 时有足够的样本量进行可靠测量，而在 alpha 0.8 时有 75.0%的测量指标有足够的样本量进行可靠测量。大多数居民层面的测量结果被认为可靠性较低。