McGlynn E A, Asch S M
Center for Research on Quality in Health Care, RAND Health, Health Services Research and Development, West Los Angeles Veterans Administration and Health Program, Santa Monica, CA 90401, USA.
Am J Prev Med. 1998 Apr;14(3 Suppl):14-21. doi: 10.1016/s0749-3797(97)00032-9.
Clinical performance measurement is an increasingly important way for public and private purchasers alike to compare the value of health services provided by competing health delivery systems. The widespread use of performance measures has increased the demand for development of new measures that cover previously unevaluated aspects of care.
Four steps required to develop a clinical performance measure that is suitable for making comparisons among health delivery systems are discussed: (1) choosing clinical areas to measure, (2) selecting performance indicators within each area, (3) designing specifications for consistent implementation of a measure, and (4) evaluating the scientific strength of a measure.
The application of these steps to developing measures of quality for hypertension is provided, with an emphasis on a measure of adequacy of control of blood pressure.
Developing useful clinical performance measures requires careful attention to methodologic issues. Following the steps outlined in this paper should enhance the quality of future measurement development.
临床绩效评估对于公共和私人购买者而言，正日益成为一种比较相互竞争的医疗服务体系所提供的卫生服务价值的重要方式。绩效指标的广泛使用增加了对开发新指标的需求，这些新指标要涵盖以往未评估的护理方面。
讨论了制定适用于在医疗服务体系之间进行比较的临床绩效指标所需的四个步骤：（1）选择要测量的临床领域，（2）在每个领域内选择绩效指标，（3）设计指标一致实施的规范，以及（4）评估指标的科学强度。
提供了将这些步骤应用于制定高血压质量指标的情况，重点是血压控制充分性的指标。
制定有用的临床绩效指标需要仔细关注方法学问题。遵循本文概述的步骤应能提高未来指标开发的质量。
