Schroeder S A, Donaldson M S
Med Care. 1976 Jan;14(1):49-56. doi: 10.1097/00005650-197601000-00005.
Recent federal legislation has contained the stipulation that participating health maintenance organizations (HMOs) include a quality assurance program which stresses health outcomes. This provision was ostensibly directed at correcting alleged abuses in HMOs serving the urban poor. One version of the outcome method was employed for an 18-month period at an urban HMO caring for 2,000 Medicaid subscribers. The program involved comparing diagnostic accuracy and therapeutic outcomes for clinical conditions relevant to the study population with ideal standards established by the HMO. Three conditions were selected: contraception, depression, and hypertension. The results revealed widespread underdiagnosis (44-74%) in each condition and unacceptable therapeutic outcomes in two. Data collection was hampered by shifts in geography and financial eligibility among the denominator population and low response rates (38-63%) to telephone and mail surveys. Applying the general project guidelines to specific conditions proved considerably more difficult than anticipated. Further refinement of this approach to quality assessment must occur before its widespread use is feasible. Its effectiveness in improving quality remains to be seen. This experience raises doubts regarding the wisdom of legislating a specific outcome approach to quality assessment before feasibility and effectiveness have been demonstrated in organized health settings.
最近的联邦立法规定，参与的健康维护组织（HMO）应包括一个强调健康结果的质量保证计划。这项规定表面上是为了纠正服务于城市贫困人口的HMO中所谓的滥用行为。在一个为2000名医疗补助受保人提供服务的城市HMO中，为期18个月采用了一种结果评估方法。该计划包括将与研究人群相关的临床病症的诊断准确性和治疗结果与HMO制定的理想标准进行比较。选择了三种病症：避孕、抑郁症和高血压。结果显示，每种病症都存在广泛的诊断不足（44%-74%），其中两种病症的治疗结果不可接受。分母人群在地理位置和财务资格方面的变化以及电话和邮件调查的低回复率（38%-63%）阻碍了数据收集。将一般项目指南应用于具体病症比预期困难得多。在这种质量评估方法能够广泛应用之前，必须对其进行进一步完善。其在提高质量方面的有效性还有待观察。在有组织的健康环境中证明可行性和有效性之前，就通过立法规定一种特定的质量评估结果方法是否明智，这一经验引发了质疑。
