Improving the quality of quality measurement: the tinkerer, the tailor and the candlestick maker.
Improving the quality of quality measurement: the tinkerer, the tailor and the candlestick maker.
复制标题
提高质量测量的质量：修补匠、裁缝和烛台制造商。
DOI：
10.1097/mlr.0b013e3181a14b65
复制
发表时间：
2009
期刊：
影响因子：
3
通讯作者：
Safford,MonikaM
中科院分区：
文献类型：
--
作者：
Safford,MonikaM
The US healthcare industry has been assessing the quality of healthcare using public reporting for nearly 15 years now. As far back as 2003, reports began to indicate measurable improvements in quality indicators. 1 Yet, these early signs of success were not enough, as many individuals continued to receive suboptimal care. The pay-for-performance experiment ensued, with reimbursements tied to quality in hopes of stimulating more improvements.In the midst of this tour de force of commitment to improving quality of care in the United States, several dissenting voices were heard. Early critics pointed to shortcomings of quality measures that assess the proportion of individuals above a certain risk factor level, such as blood pressure> 140/90 mm Hg. Thresholds ignore the very real benefits derived from lowering a risk factor from a high to a moderate level, which has greater health impact than bringing someone from just above goal to just below it. Yet, quality indicators based on thresholds equate these two very different clinical and quality scenarios. Additional troublesome signs began to emerge in reports confirming that some indicators based on risk factor achievement were influenced by patient characteristics, like the age of the patients or the severity of their illness. 2, 3 These characteristics do not reflect quality of care, and the possibility of unfairness in quality comparisons began to be discussed. Moreover, other reports began to raise the possibility that some quality indicators related to testing risk factors may not be associated with improved health outcomes. 4 The report by Mangione et al found associations between health plan clinical care management and testing rates, but not risk factor levels. 4 Added to these issues is a growing concern that an overall picture of quality of care is not reflected well in individual quality measures.
登录
查看更多内容
社会人口统计案例组合对健康计划质量 HEDIS 衡量标准的影响
影响因子：
3
作者：
A. Zaslavsky;J. Hochheimer;E. Schneider;P. Cleary;J. Seidman;E. McGlynn;Joseph W. Thompson;C. Sennett;A. Epstein
通讯作者：
A. Epstein
影响因子：
120.7
作者：
Jencks, SF;Huff, ED;Cuerdon, T
通讯作者：
Cuerdon, T
影响因子：
158.5
作者：
Schulman, KA;Berlin, JA;Escarce, JJ
通讯作者：
Escarce, JJ
影响因子：
16.2
作者：
Zhang, QW;Safford, M;Pogach, LM
通讯作者：
Pogach, LM