Palmer R H, Strain R, Maurer J V, Rothrock J K, Thompson M S
Med Care. 1984 Jul;22(7):632-43. doi: 10.1097/00005650-198407000-00005.
Four evaluations of ambulatory medical care tasks were developed for use in quality assurance. The evaluations used medical records data and explicit criteria incorporating branching logic. They were implemented in eight general medicine provider groups in two teaching hospitals and six related health centers. Agreement with criteria among 316 provider responses to questionnaires varied from 57% to 100%. The percentage of cases with one or more variation from evaluation criteria, confirmed on peer review to have a deficiency in care, ranged by task from 6% to 42%, with substantial variation between sites. Physician reviewers from each site varied in leniency. Numbers of actions taken to correct deficiencies ranged by site and task from zero to six. Multisite evaluations revealed differences in performance and efforts to improve that are not apparent when each site conducts its own evaluations. More uniformly effective and impartial quality assurance is needed to correct some important deficiencies in care observed in this study.
为质量保证目的，开发了四项门诊医疗护理任务评估。这些评估使用病历数据和包含分支逻辑的明确标准。它们在两家教学医院的八个普通内科医疗服务提供组以及六个相关健康中心实施。在对问卷的316份提供者回复中，与标准的一致性从57%到100%不等。经同行评审确认存在护理缺陷的、与评估标准有一个或多个差异的病例百分比，按任务从6%到42%不等，各地点之间存在很大差异。每个地点的医师评审员在宽松程度上各不相同。为纠正缺陷而采取的行动数量按地点和任务从零到六个不等。多地点评估揭示了各地点在表现和改进努力方面的差异，而当每个地点自行进行评估时这些差异并不明显。需要更统一有效的公正质量保证来纠正本研究中观察到的一些重要护理缺陷。
