Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality.
Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality.
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DOI：
10.1016/j.healthpol.2020.02.012
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发表时间：
2020-05
期刊：
影响因子：
--
通讯作者：
Rothstein H
中科院分区：
文献类型：
--
作者：
Beaussier AL;Demeritt D;Griffiths A;Rothstein H
指标集在如何定义，测量和评估医疗质量方面有所不同。不同的治理传统和医疗保健系统配置形成的国家集。针对特定系统“需求方”压力形成的质量维度和医院活动。衡量方式受数据访问和指标构建方面的“供应方”限制的影响。当医疗体系和治理传统相似时，国际基准比较容易。尽管人们普遍认为质量指标是医疗保健改善和监管的关键，但令人惊讶的是，人们对不同国家实际测量的内容、方法和原因知之甚少。为了弥补这一差距，本文比较了英国、德国、法国和荷兰法定医院监管机构使用的官方指标集--包括约1100项质量指标。研究结果表明，这些国家的监管机构在以下方面取得了非常不同的平衡：他们评估的质量维度（例如安全性，有效性和以患者为中心）;他们针对的医院活动（例如临床和非临床活动和管理）;以及他们指标的“多纳贝迪安”测量风格（结构，过程和结果指标之间）。我们认为，这些对比反映了：i）每个国家的医疗保健系统面临的独特问题如何对国家指标集测量的内容产生不同的“需求方”压力; ii）国家医疗保健系统和治理传统的配置如何对监管机构可以用于指标构建的数据类型产生“供应方”约束。我们的分析表明，各国在质量的含义及其衡量方面存在根本差异，这可能会阻碍国际社会衡量质量和确定最佳做法的努力。
Indicator sets differ in how they define, measure, and assess healthcare quality. National sets shaped by varying governance traditions and healthcare system configuration. Targeting of quality dimensions and hospital activities shaped by system-specific ‘demand-side’ pressures. Measurement styles shaped by ‘supply-side’ constraints on data access and indicator construction. International benchmarking is easier when healthcare systems and governance traditions are similar. Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets--comprising some 1100 quality measures-- used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target (e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country’s healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.
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影响因子：
3.3
作者：
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通讯作者：
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影响因子：
5.4
作者：
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影响因子：
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作者：
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计算失败：基于风险的监管以及确保NHS医疗保健质量的问题。
DOI：
10.1080/13698575.2016.1192585
发表时间：
2016-05-18
期刊：
Health, risk & society
影响因子：
--
作者：
Beaussier AL;Demeritt D;Griffiths A;Rothstein H
通讯作者：
Rothstein H