Quality and Cost in Community Health Centers.
Quality and Cost in Community Health Centers.
复制标题
社区卫生中心的质量和成本。
DOI：
10.1097/mlr.0000000000001571
复制
发表时间：
2021
期刊：
影响因子：
3
通讯作者：
Dor,Avi
中科院分区：
文献类型：
--
作者：
Carey,Kathleen;Luo,Qian;Dor,Avi
背景：卫生保健质量的量化长期以来一直是确定提供者水平的质量和成本之间的关系的挑战。然而，对质量改进的日益关注导致了对组织绩效的更大兴趣，促使支付者收集可以在提供者层面组合的各种质量指标。目的：使用综合质量测量来探索美国社区卫生中心(CHC)提供的质量与平均成本之间的关系。研究设计：使用初级保健局收集的统一数据系统，我们结合2015-2018年间美国1331家社区卫生中心提供的9个过程和2个结果指标，构建了综合测量指标。我们探索了不同的权重方案和在慢性病控制、筛查和药物管理的中间领域水平构建的个人质量指标的不同组合。我们使用广义线性模型来回归综合质量指标的平均就诊成本，控制了患者和健康中心的因素。与中间领域水平相比，我们在总体水平上检验了结果对不同加权方案以及对组合单个质量指标的敏感性。结果：总体水平和领域水平组合在估计中表现良好。每次就诊的平均成本与质量呈负相关，尽管影响的大小在不同的加权方案中有所不同。结论：努力提高CHC提供的初级卫生保健质量不需要付出更大的成本。
Background:Quantifying health care quality has long presented a challenge to identifying the relationship between provider level quality and cost. However, growing focus on quality improvement has led to greater interest in organizational performance, prompting payers to collect various indicators of quality that can be combined at the provider level.Objective:To explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality.Research Design:Using the Uniform Data System collected by the Bureau of Primary Care, we constructed composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015–2018. We explored different weighting schemes and different combinations of individual quality indicators constructed at the intermediate domain levels of chronic condition control, screening, and medication management. We used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors. We examined the sensitivity of results to different weighting schemes and to combining individual quality indicators at the overall level compared with the intermediate domain level.Results:Both overall and domain level composites performed well in the estimations. Average cost of a medical visit was negatively associated with quality, although the magnitude of the effect varied across weighting schemes.Conclusion:Efforts toward improvement of primary health care quality delivered in CHCs need not involve greater cost.