Berlowitz D R, Anderson J J, Ash A S, Brandeis G H, Brand H K, Moskowitz M A
Center for Health Quality, Outcomes, and Economic Research, Bedford VA Hospital, MA 01730, USA.
Med Care. 1998 Jun;36(6):818-25. doi: 10.1097/00005650-199806000-00005.
The authors evaluated methods of reporting on rates of pressure ulcer development in long-term care to identify approaches that lead to more stable estimates of actual performance.
Performance measures for facilities that adequately adjust for both random variation and casemix should be relatively stable from one time period to the next. The authors calculated facility rates of pressure ulcer development over eight consecutive time periods and correlated measures over time using different reporting methods including z-scores, combining rates from several time periods, and limiting analyses to large facilities. Results were compared with a Monte Carlo simulation.
Observed facility rates of pressure ulcer development varied considerably over time. The average correlation coefficient across seven time comparisons for observed rates was 0.17. Reporting performance as a z-score or limiting the analyses to large facilities increased the correlation. Combining two time periods was effective only when used with one of these other approaches. The correlation coefficient based on a simulation using only large facilities was 0.51.
Random variation affects reported rates of pressure ulcer development. Using only large facilities and combining two time periods limits the effects of random variation and results in more stable estimates of performance. When describing performance, management must consider tradeoffs between having more accurate data, the frequency with which data are provided, and whether it is given to all providers.
作者评估了长期护理中压力性溃疡发生率的报告方法，以确定能得出更稳定的实际表现估计值的方法。
对随机变异和病例组合均进行充分调整的机构绩效指标应在不同时间段内相对稳定。作者计算了连续八个时间段内机构压力性溃疡的发生率，并使用不同的报告方法（包括z分数、合并多个时间段的发生率以及将分析限于大型机构）对不同时间段的指标进行相关性分析。结果与蒙特卡洛模拟进行比较。
观察到的机构压力性溃疡发生率随时间有很大差异。观察到的发生率在七次时间比较中的平均相关系数为0.17。将绩效报告为z分数或将分析限于大型机构可提高相关性。仅在与其他方法之一结合使用时，合并两个时间段才有效。仅使用大型机构进行模拟得出的相关系数为0.51。
随机变异会影响报告的压力性溃疡发生率。仅使用大型机构并合并两个时间段可限制随机变异的影响，并得出更稳定的绩效估计值。在描述绩效时，管理层必须考虑在获得更准确的数据、数据提供频率以及是否向所有提供者提供数据之间进行权衡。
