Phillips K A, Luft H S
Center for AIDS Prevention Studies, University of California, San Francisco 94015, USA.
Int J Qual Health Care. 1997 Oct;9(5):341-8. doi: 10.1093/intqhc/9.5.341.
There is growing interest in the quality of health care and in using quality measures to direct patients to hospitals and providers offering high quality, low cost health care. The dilemma is that, while there is an increasing need for quality indicators as a result of a changing health care environment, this changing environment has important implications for the use of some of these measures. Since the 1970s, a growing body of research in the U.S. has addressed the empirical relationship between the number of patients with a specific diagnosis of surgical procedure and their outcomes after treatment in a particular hospital or by a particular physician ("volume-outcome" studies). In this paper, we examine the policy implications of using hospital and physician volume information as an "indicator" of quality in a rapidly changing health care environment with new players and new incentives. We begin by describing the evolution of the use of volumes within both regulatory and market-oriented contexts in the U.S. We then discuss policy considerations and cautions in using volumes, along with suggestions for future research. Our purpose is to point out potential problems and clarify confusions about the use of volumes, so that policymakers and practitioners can be sensitive to the potential minefields they are traversing.
人们越来越关注医疗保健质量，并希望利用质量指标引导患者前往提供高质量、低成本医疗服务的医院和医疗服务提供者。困境在于，尽管由于不断变化的医疗保健环境，对质量指标的需求日益增加，但这种变化的环境对其中一些指标的使用具有重要影响。自20世纪70年代以来，美国越来越多的研究探讨了特定手术诊断患者数量与其在特定医院或由特定医生治疗后的结果之间的实证关系（“数量-结果”研究）。在本文中，我们研究在一个新参与者和新激励措施不断涌现、快速变化的医疗保健环境中，将医院和医生数量信息用作质量“指标”的政策含义。我们首先描述美国在监管和市场导向背景下数量使用的演变。然后我们讨论使用数量时的政策考虑因素和注意事项，以及对未来研究的建议。我们的目的是指出使用数量时的潜在问题并澄清困惑，以便政策制定者和从业者能够对他们正在涉足的潜在雷区保持敏感。
