Denis Agniel (
Irineo Cabreros, RAND Corporation.
Health Aff (Millwood). 2023 Oct;42(10):1383-1391. doi: 10.1377/hlthaff.2022.01483.
Quality measurement is an important tool for incentivizing improvement in the quality of health care. Most quality measurement efforts do not explicitly target health equity. Although some measurement approaches may intend to realign incentives to focus quality improvement efforts on underserved groups, the extent to which they accomplish this goal is understudied. We posit that tying incentives to approaches on the basis of stratification or disparities may have unintended consequences or limited effects. Such approaches might not reduce existing disparities because addressing one aspect of equity may be in competition with addressing others. We propose equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. We use colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.
质量测量是激励医疗保健质量改进的重要工具。大多数质量测量工作并未明确针对公平性。尽管一些测量方法可能旨在调整激励机制，将质量改进工作的重点放在服务不足的群体上，但对于这些方法在多大程度上实现了这一目标，研究还不够充分。我们假设，根据分层或差异将激励措施与方法联系起来可能会产生意想不到的后果或有限的效果。这些方法可能不会减少现有的差距，因为解决公平性的一个方面可能与解决其他方面相竞争。我们提出公平权重，这是一种新的测量框架，可以在多个方面推进公平性，解决现有方法的缺点，并明确调整激励措施以符合公平性目标。我们使用 2017 年医疗保险索赔中得出的结直肠癌筛查数据来说明公平权重如何纠正其他方法中的意外后果，以及如何将其适应政策目标。
