Rosenthal G E, Harper D L
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
Jt Comm J Qual Improv. 1994 Aug;20(8):425-42. doi: 10.1016/s1070-3241(16)30088-8.
Cleveland Health Quality Choice Coalition was established in 1989 as a voluntary, collaborative effort between hospitals, physicians, and purchasers in the Cleveland metropolitan area to assess the quality and efficiency of care in 31 hospitals. The objective of the project is to produce high-fidelity comparative hospital outcomes data that support market-based health care reform strategies.
The project reports on a broad spectrum of hospital outcomes, including patient satisfaction, in-hospital mortality, length of stay, hospital-acquired complications, and cesarean section rates for adult medical, surgical, obstetrical, and intensive care patients. Intensive care outcomes and patient satisfaction are assessed using previously validated measurement systems. Outcomes for medical, surgical, and obstetrical patients are examined using a standardized data collection and severity adjustment methodology developed by Cleveland physicians and an independent consultant.
The project released its initial report to purchasers in April 1993, with subsequent reports scheduled for release every six months. Several policies, procedures, and programs have been instituted to ensure data quality and participant buy-in. These include initial testing and rigorous validation of all outcomes measurement systems before release of data, a commitment to continuously refine risk-adjustment methodologies, independent auditing of data reliability, and a series of user-training workshops for project participants and local news media.
The early success of Cleveland Health Quality Choice Coalition demonstrates that it is possible for purchasers and providers to cooperatively assess the quality of health care on a regional basis and to institute a market-based strategy for health care reform. Further evaluation is needed to determine how performance data being reported are used by purchasers in selecting health care and by hospitals for quality improvement.
克利夫兰健康质量选择联盟成立于1989年，是克利夫兰都会区的医院、医生和采购方之间的一项自愿合作项目，旨在评估31家医院的医疗质量和效率。该项目的目标是生成高保真的医院对比结果数据，以支持基于市场的医疗改革策略。
该项目报告了广泛的医院结果，包括患者满意度、住院死亡率、住院时间、医院获得性并发症以及成人内科、外科、产科和重症监护患者的剖宫产率。重症监护结果和患者满意度使用先前验证过的测量系统进行评估。内科、外科和产科患者的结果使用由克利夫兰医生和一名独立顾问开发的标准化数据收集和严重程度调整方法进行检查。
该项目于1993年4月向采购方发布了初始报告，随后的报告计划每六个月发布一次。已经制定了几项政策、程序和计划，以确保数据质量和参与者的认可。这些措施包括在发布数据之前对所有结果测量系统进行初步测试和严格验证、承诺不断完善风险调整方法、对数据可靠性进行独立审计，以及为项目参与者和当地新闻媒体举办一系列用户培训研讨会。
克利夫兰健康质量选择联盟的早期成功表明，采购方和供应商有可能在区域基础上合作评估医疗质量，并制定基于市场的医疗改革策略。需要进一步评估，以确定采购方在选择医疗服务时如何使用所报告的绩效数据，以及医院如何利用这些数据进行质量改进。
