Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.
Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.
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DOI：
10.1186/1471-2296-12-85
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发表时间：
2011-08-10
影响因子：
2.9
通讯作者：
Lester HE
中科院分区：
文献类型：
--
作者：
Campbell SM;Kontopantelis E;Hannon K;Burke M;Barber A;Lester HE
质量措施在实际使用之前应遵循测试协议，使用可接受性、可行性和可靠性等关键属性，并识别实际实施中产生的问题和意外后果。我们使用英国质量和成果框架 (QOF) 拟议质量指标的数据描述了指标测试协议 (ITP) 的方法和结果。指标测试协议涉及多步骤和方法过程：1）兰德/加州大学洛杉矶分校适当方法，测试清晰度和必要性，2）从患者病历中提取数据，测试技术可行性和可靠性，3）日记，测试工作量，4）成本效益建模，5）半结构化访谈，测试可接受性、实施问题和意外后果。测试是在英格兰具有代表性的家庭实践样本中进行的。这些方法被组合成每个测试指标的总体建议。使用指标测试协议作为试点的一部分被视为在“现实世界”环境中测试潜在指标的一种有价值的方法。试点一（2009年10月-2010年3月）涉及六个临床领域的13个指标，其中12个指标通过了指标测试方案。然而，指标测试协议发现了许多实施问题和意外后果，可以在全国推广之前纠正或消除。姑息治疗指标被用作使用多属性指标测试协议进行试点的价值的范例 - 虽然技术上可行且可靠，但实践人员无法接受，并引起了对可能造成实际患者伤害的担忧。该指标测试协议是协议的一个示例，当适应特定国家的医疗保健环境时，该协议可能有助于评估潜在的质量指标，并且可能有助于全世界的政策制定者和研究人员在推出之前测试实施指标的可能效果。它以现有文献和其他测试协议为基础并对其进行编纂，以创建一种现场测试方法，可用于为按绩效付费或质量改进计划生成特定于国家/地区的质量指标。
Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.
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