Quality Improvement, Local Initiative Health Authority, Los Angeles, California, USA
Quality Improvement, Local Initiative Health Authority, Los Angeles, California, USA.
BMJ Open Qual. 2023 Jul;12(3). doi: 10.1136/bmjoq-2022-001906.
Healthcare organisations in the USA rank significantly lower in quality of care compared with other developed nations. Research shows US performance emphasises expensive treatment over effective prevention programmes. This study demonstrates how a comprehensive quality improvement programme can improve health outcomes in a large county-based Medicaid health plan. The health plan serves a diverse community of members spanning racial and ethnic groups with varying levels of clinical risk and social determinants of health burdens. We used a regression discontinuity design to evaluate the impact of a comprehensive quality improvement programme vs using mainly pay-for-performance on Healthcare Effectiveness Data and Information Set (HEDIS) metrics over the course of 10 years. We found significant improvements in several HEDIS metrics that occurred after the quality improvement programme was implemented. These results demonstrate the importance of using a comprehensive quality improvement strategy along with pay-for-performance to improve health outcomes. It was determined that this research was exempt from institutional review board approval, as it used administrative healthcare data, and did not involve direct interventions with human subjects.
美国的医疗保健组织在医疗质量方面的排名明显低于其他发达国家。研究表明，美国的表现强调昂贵的治疗方法，而不是有效的预防方案。本研究展示了一个全面的质量改进计划如何改善一个大型基于医疗补助的医疗保健计划中的健康结果。该医疗保健计划为不同种族和族裔群体的成员提供服务，这些成员的临床风险和健康负担的社会决定因素各不相同。我们使用回归不连续性设计来评估全面质量改进计划对医疗保健效果数据和信息集（HEDIS）指标的影响，在 10 年的时间里主要使用基于绩效的支付方式。我们发现，在实施质量改进计划后，HEDIS 指标中的几个指标有了显著的改善。这些结果表明，使用全面的质量改进策略以及基于绩效的支付方式对于改善健康结果非常重要。确定本研究无需机构审查委员会批准，因为它使用了行政医疗保健数据，并且不涉及与人类受试者的直接干预。
