Statistical benchmarks for process measures of quality of care for mental and substance use disorders
Statistical benchmarks for process measures of quality of care for mental and substance use disorders
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DOI：
10.1176/appi.ps.57.10.1461
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发表时间：
2006-10-01
影响因子：
3.8
通讯作者：
Chiu, Wai T.
中科院分区：
文献类型：
--
作者：
Hermann, Richard C.;Chan, Jeffrey A.;Chiu, Wai T.
目的：基准，表现最好的提供者所取得的业绩水平，可以用来设定可实现的目标，以改善护理，但他们迄今为止还没有提供精神卫生保健。本文介绍了一种方法的应用程序开发的统计基准的12个过程的措施，精神和物质使用障碍的护理质量。研究方法：12个质量措施，从一个多利益相关者小组通过正式的共识过程中选择的核心措施集，构建了1994-1995年的医疗补助受益人在六个州收到的护理行政数据。在提供者水平计算并发症发生率，并以平均值、第90百分位数结果和统计基准表示。每项措施的样本量从356到4，494名提供者不等，从1，205到78，627例不等。三项措施涉及抗抑郁治疗，两项涉及抗精神病治疗，一项涉及双相情感障碍的情绪稳定剂。其他六项措施涉及后续治疗访视。结果如下：供应商级绩效的基准范围从59.7%到97.7%，明显高于平均结果，从9.4%到65.4%。基准结果变化很大，与第90百分位数的供应商的这些措施的结果相反，并在不同的临床过程中应用相同的数值目标的性能标准。结论：统计基准可以应用于精神卫生保健质量评估的结果。进一步的研究应审查将基准纳入质量改进活动是否会导致更好的精神保健和与药物有关的保健以及更好的结果。
Objective: Benchmarks, representing the level of performance achieved by the best-performing providers, can be used to set achievable goals for improving care, but they have not heretofore been available for mental health care. This article describes the application of a method for developing statistical benchmarks for 12 process measures of quality of care for mental and substance use disorders. Methods: Twelve quality measures-taken from a core measure set selected by a multistakeholder panel through a formal consensus process-were constructed from 1994-1995 administrative data on care received by Medicaid beneficiaries in six states. Conformance rates were calculated at the provider level and presented as means, 90th-percentile results, and statistical benchmarks. Sample sizes for each measure ranged from 356 to 4,494 providers and from 1,205 to 78,627 cases. Three measures involved antidepressant treatment, two involved antipsychotic treatment, and one involved mood stabilizers for bipolar disorder. Six other measures involved follow-up treatment visits. Results: Benchmarks for provider-level performance ranged from 59.7 percent to 97.7 percent, markedly higher than the mean results, which ranged from 9.4 percent to 65.4 percent. Benchmark results varied widely-in contrast to results for these measures at the 90th percentile of providers and in contrast to performance standards that apply the same numerical goal across varied clinical processes. Conclusions: Statistical benchmarks can be applied to results from quality assessment of mental health care. Further research should examine whether incorporating benchmarks into quality improvement activities leads to better mental health care and substance-related care and improved outcomes.