Zinn J S, Aaronson W E, Rosko M D
Department of Health Administration, Temple University, Philadelphia, PA 19122.
Am J Med Qual. 1993 Summer;8(2):72-8. doi: 10.1177/0885713X9300800209.
The Institute of Medicine recommends the use of key quality indicators (resident outcomes that suggest the presence of good or bad care) as tools for interfacility comparison of the quality of care provided in nursing homes. In the spirit of this recommendation, the Health Care Financing Administration released selected results from its Medicare and Medicaid Annual Certification Survey to guide consumers in purchasing nursing home services. However, because this information is published without adjustment for resident characteristics that can influence the outcomes of nursing home care, its utility for policy-makers or consumers interested in variation in nursing home quality is limited. This research study utilizes federal and state survey data to evaluate variations in mortality, pressure ulcers, urethral catheterization, and physical restraint use in 438 Medicare-certified skilled nursing care facilities in Pennsylvania. A standardization function adjusting for resident characteristics known to influence outcomes is developed and estimated by ordinary least squares regression. Results suggest considerable variation in rates for these indicators across Pennsylvania nursing home facilities. Alternative uses for risk-adjusted key quality indicators as tools for improving nursing home quality and assisting potential consumers of nursing home care in making better informed choices are considered.
医学研究所建议使用关键质量指标（表明护理质量好坏的住院患者结果）作为疗养院护理质量机构间比较的工具。本着这一建议的精神，医疗保健财务管理局公布了其医疗保险和医疗补助年度认证调查的部分结果，以指导消费者购买疗养院服务。然而，由于这些信息在发布时未针对可能影响疗养院护理结果的住院患者特征进行调整，因此对于关注疗养院质量差异的政策制定者或消费者而言，其效用有限。本研究利用联邦和州的调查数据，评估宾夕法尼亚州438家获得医疗保险认证的专业护理机构在死亡率、压疮、尿道插管和使用身体约束方面的差异。通过普通最小二乘法回归开发并估计了一个针对已知会影响结果的住院患者特征进行调整的标准化函数。结果表明，宾夕法尼亚州各疗养院这些指标的发生率存在显著差异。还考虑了将风险调整后的关键质量指标用作改善疗养院质量以及帮助疗养院潜在消费者做出更明智选择的工具的其他用途。
