Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, California.
Stat Med. 2024 Oct 15;43(23):4575-4594. doi: 10.1002/sim.10197. Epub 2024 Aug 15.
Quality measurement plays an increasing role in U.S. health care. Measures inform quality improvement efforts, public reporting of variations in quality of care across providers and hospitals, and high-stakes financial decisions. To be meaningful in these contexts, measures should be reliable and not heavily impacted by chance variations in sampling or measurement. Several different methods are used in practice by measure developers and endorsers to evaluate reliability; however, there is uncertainty and debate over differences between these methods and their interpretations. We review methods currently used in practice, pointing out differences that can lead to disparate reliability estimates. We compare estimates from 14 different methods in the case of two sets of mental health quality measures within a large health system. We find that estimates can differ substantially and that these discrepancies widen when sample size is reduced.
质量测量在美国医疗保健中扮演着越来越重要的角色。这些测量指标可以为质量改进工作提供信息，为不同医疗机构和医院之间的医疗质量变化提供公共报告，并为高风险的财务决策提供依据。为了在这些背景下具有意义，这些指标应该是可靠的，并且不受抽样或测量中偶然变化的严重影响。在实践中，指标的开发者和支持者使用了几种不同的方法来评估可靠性；然而，对于这些方法及其解释之间的差异，仍然存在不确定性和争议。我们回顾了目前在实践中使用的方法，指出了可能导致可靠性估计值不同的差异。我们在一个大型医疗系统中比较了两套心理健康质量指标的 14 种不同方法的估计值。我们发现，估计值可能会有很大的差异，并且当样本量减少时，这些差异会扩大。
