Garnick D W, Lawthers A G, Palmer R H, Moentmann S J, Fowles J, Weiner J P
Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, MA 02254-9110.
Jt Comm J Qual Improv. 1994 Dec;20(12):679-94. doi: 10.1016/s1070-3241(16)30117-1.
Review of clinical performance in office-based care is increasing in importance as more medical care shifts to outpatient settings. Decisions made in primary care settings can save lives and limit disability through prevention and early intervention in disease. Information is needed to assess quality of care by answering such questions as whether drugs are prescribed and monitored appropriately, follow-up on serious health threats is carried out promptly, or procedures are performed for appropriate indications. Moreover, data from medical records are essential to provide important clinical information not found in the more widely used administrative data sets. Managed care organizations, too, face the need to respond to requests for objective information about the quality of primary care that they provide. Those organizations now planning assessments of primary care will need to consider the cost of obtaining information from medical record review.
The DEMPAQ Record Review System (DRRS) is a tool for peer review organizations (PROs) to use to review ambulatory care given to Medicare beneficiaries in physicians' offices. The system is described in terms of functions (activities commonly performed in the course of an office visit, such as drug prescribing), indicators (summary measures of quality for each key function of clinical care), and clinical items (for example, specific drugs or tests for each function and indicator)--a total of 263 indicators in all. A framework is provided for measuring the operational costs of a review system based on medical records.
The costs directly associated with a fully operational review system were less than $48 per case in Iowa and Alabama and $72 per case in Maryland. On average, reviewers spent about an hour per case signed on to DRRS; average review times declined over time with practice. About half the cost of the review process is accounted for by administrative costs. Therefore, once the effort has been made to obtain records, the additional cost of abstracting more data items is relatively low. Since samples of 300-500 records suffice to measure average performance for a region or state, costs per region/state approximate $15,000 to $25,000 per measurement cycle for assessment of a wide array of clinical areas.
The cost of collecting information on quality of care from medical records using the review system falls within current budgets for PRO review. However, organizations planning to implement a quality improvement campaign should also consider the costs of analyzing the data, reporting information to physicians, and continuing to monitor changes in performance.
随着越来越多的医疗服务转向门诊环境，对门诊医疗服务临床绩效的评估变得愈发重要。初级保健机构做出的决策可以通过疾病预防和早期干预挽救生命并减少残疾。需要通过回答诸如药物处方和监测是否得当、严重健康威胁是否得到及时跟进或手术是否有适当指征等问题来评估医疗质量。此外，病历数据对于提供在更广泛使用的管理数据集里找不到的重要临床信息至关重要。管理式医疗组织也面临着回应关于其提供的初级保健质量的客观信息请求的需求。那些正在计划对初级保健进行评估的组织将需要考虑从病历审查中获取信息的成本。
DEMPAQ病历审查系统（DRRS）是同行评审组织（PROs）用于审查医生办公室为医疗保险受益人提供的门诊医疗服务的工具。该系统从功能（门诊就诊过程中通常执行的活动，如开药）、指标（临床护理各关键功能的质量汇总指标）和临床项目（例如，每个功能和指标的特定药物或检查）方面进行了描述，总共263个指标。提供了一个基于病历的审查系统运营成本测量框架。
在爱荷华州和阿拉巴马州，与一个全面运行的审查系统直接相关的成本低于每例48美元，在马里兰州为每例72美元。平均而言，评审人员处理每个DRRS病例花费约一小时；随着实践的推移，平均审查时间有所下降。审查过程成本的大约一半由行政成本构成。因此，一旦努力获取了病历，提取更多数据项的额外成本相对较低。由于300 - 500份病历样本足以衡量一个地区或州的平均绩效，每个地区/州每个测量周期评估广泛临床领域的成本约为15,000美元至25,000美元。
使用审查系统从病历中收集医疗质量信息的成本在当前PRO审查预算范围内。然而，计划开展质量改进活动的组织还应考虑分析数据、向医生报告信息以及持续监测绩效变化的成本。
Zotero 插件