Achieving consensus across diverse stakeholders on quality measures for mental healthcare
Achieving consensus across diverse stakeholders on quality measures for mental healthcare
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DOI：
10.1097/00005650-200412000-00012
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发表时间：
2004-12-01
期刊：
影响因子：
3
通讯作者：
Lagodmos, G
中科院分区：
文献类型：
--
作者：
Hermann, RC;Palmer, H;Lagodmos, G
目的：由于缺乏对有意义和可行的护理措施的共识，质量改进工作受到阻碍。本研究的目的是为精神卫生和物质相关护理制定一套核心质量措施，这些措施对利益相关者有意义，实施可行，并广泛代表精神卫生系统的各个方面。方法：由来自国家组织的12名利益相关者组成的小组评估了两阶段修改的德尔菲共识开发过程中的116项过程措施。在概念框架和文献回顾的基础上，小组成员使用9分制对7个领域的每个措施进行了评分（1 =最好）。然后将度量映射到系统维度框架，以确定每个维度中具有最高系统特征评级的核心集。结果：共确定了28项措施，分别评估治疗（12）、可及性(2)、评估(2)、连续性(4)、协调性(2)、预防(1)和安全性(5)。总体而言，对意义的平均评分为：临床重要性2.29；实际护理与最佳护理感知差距2.59；改善的表现和结果之间的关系2.61。可行性方面，规范清晰度平均评分为3.39；数据收集负担的可接受性4.77；病例组合调整的充分性4.20。这些措施涉及一系列治疗方式、临床环境、诊断类别、弱势群体和精神卫生保健的其他方面。结论：一个结构化的共识过程确定了一套核心的质量措施是有意义的和可行的多个利益相关者，以及广泛代表精神卫生保健系统。通过对利益攸关方之间的意义、可行性和共识程度进行定量评估，这些结果可以为正在进行的国家努力提供信息，以采取共同的精神保健质量措施。
Objective: Quality-improvement efforts are hindered by a lack of consensus on meaningful and feasible measures of care. The objective of this study was to develop a core set of quality measures for mental health and substance-related care that are meaningful to stakeholders, feasible to implement, and broadly representative of diverse dimensions of the mental health system.Method: A 12-member panel of stakeholders from national organizations evaluated 116 process measures in a 2-stage modified Delphi consensus development process. Drawing on a conceptual framework and literature review, panelists rated each measure on 7 domains using a 9-point scale (1 = best). Measures were then mapped to a framework of system dimensions to identify a core set with the highest ratings for system characteristics within each dimension.Results: Twenty-eight measures were identified assessing treatment (12), access (2), assessment (2), continuity (4), coordination (2), prevention (1), and safety (5). Overall, mean ratings for meaningfulness were: clinical importance 2.29; perceived gap between actual and optimal care 2.59; association between improved performance and outcome 2.61. For feasibility, mean ratings were clarity of specifications 3.39; acceptability of data collection burden 4.77; and adequacy of case mix adjustment 4.20. The measures address a range of treatment modalities, clinical settings, diagnostic categories, vulnerable populations, and other dimensions of mental healthcare.Conclusions: A structured consensus process identified a core set of quality measures that are meaningful and feasible to multiple stakeholders, as well as broadly representative of the mental healthcare system. By yielding quantitative assessments of meaningfulness, feasibility and degree of consensus among stakeholders, these results can inform ongoing national efforts to adopt common quality measures for mental healthcare.