Clinical Quality Performance in U.S. Health Centers
Clinical Quality Performance in U.S. Health Centers
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DOI：
10.1111/j.1475-6773.2012.01418.x
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发表时间：
2012-12-01
影响因子：
3.4
通讯作者：
Ngo-Metzger, Quyen
中科院分区：
文献类型：
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作者：
Shi, Leiyu;Lebrun, Lydie A.;Ngo-Metzger, Quyen
目的描述目前全国社区卫生中心的临床质量，并研究与卓越绩效相关的卫生中心特征。数据来源来自2009年统一数据系统的国家数据。数据收集/提取方法卫生中心审查患者记录并向统一数据系统报告汇总数据。研究设计检查了六项措施：孕早期产前护理、儿童免疫接种完成情况、巴氏涂片检查、低出生体重、高血压控制和糖尿病控制。在这些指标上，表现最好的25%的中心与表现较差的（最差的75%）中心进行了比较。采用Logistic回归来评估患者、提供者和机构特征对医疗中心绩效的影响。医疗中心的临床护理和结果总体上与全国平均水平相当。例如，67%的孕妇得到了及时的产前护理（全国= 68%），69%的儿童完成了免疫接种（全国= 67%），63%的高血压患者血压得到控制（全国= 48%）。根据不同的衡量标准，没有保险的病人越多的中心越不可能做得好，而拥有更多医生和服务提供者的中心越有可能做得好。结论：保健中心提供高质量护理的比率与全国平均水平相当。可以通过增加患者的保险覆盖率、增加医生的比例和使服务提供者能够为患者服务来改善绩效。
Objective To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. Data Sources National data from the 2009 Uniform Data System. Data Collection/Extraction Methods Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Study Design Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Principal Findings Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Conclusions Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.