Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample
Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample
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DOI：
10.7326/0003-4819-141-12-200412210-00010
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发表时间：
2004-12-21
影响因子：
39.2
通讯作者：
Kerr, EA
中科院分区：
文献类型：
--
作者：
Asch, SM;McGlynn, EA;Kerr, EA
背景资料：退伍军人健康管理局（VITA）已经引入了一个综合的电子病历，绩效评估和其他系统的变化，旨在改善护理。最近与其他交付系统的比较已被限制到一个小集合的indicator.Objective：比较质量的VITA护理与护理在一个国家的样本，通过使用一个全面的质量护理measure.Design：横断面比较。测量：1997年至2000年期间，通过使用基于图表的质量工具来测量质量，该工具包括针对26种条件的348个指标。结果进行了调整聚类，年龄，访问次数，和医疗条件。（67% vs. 51%;差异，16个百分点[95% CI，14 - 18个百分点]），慢性病护理（72%对59%;差异，13个百分点[CI，10至17个百分点]）和预防性护理（64%对44%;差异，20个百分点[CI，12至28个百分点]），但不适用于急性护理。VITA的优势在VITA绩效测量的目标过程中最为突出（66%对43%;差异为23个百分点[CI，21至26个百分点]），在与VITA绩效衡量无关的领域最不突出（55% vs. 50%;差异，5个百分点[CI，0至10个百分点]）。患者特征中未测量的剩余差异、国家样本中较低的应答率以及记录实践中的差异可能导致了一些观察到的差异。根据一项广泛的衡量标准，来自VITA的患者得到了更高质量的护理。在VITA已建立业绩计量和积极监测业绩的领域，差异最大。
Background: The Veterans Health Administration (VITA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators.Objective: To compare the quality of VITA care with that of care in a national sample by using a comprehensive quality-of-care measure.Design: Cross-sectional comparison.Setting: 12 VITA health care systems and 12 communities.Patients: 596 VITA patients and 992 patients identified through random-digit dialing. All were men older than 35 years of age.Measurements: Between 1997 and 2000, quality was measured by using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions. Results were adjusted for clustering, age, number of visits, and medical conditions.Results: Patients from the VITA scored significantly higher for adjusted overall quality (67% vs. 51%; difference, 16 percentage points [95% CI, 14 to 18 percentage points]), chronic disease care (72% vs. 59%; difference, 13 percentage points [CI, 10 to 17 percentage points]), and preventive care (64% vs. 44%; difference, 20 percentage points [CI, 12 to 28 percentage points]), but not for acute care. The VITA advantage was most prominent in processes targeted by VITA performance measurement (66% vs. 43%; difference, 23 percentage points [CI, 21 to 26 percentage points]) and least prominent in areas unrelated to VITA performance measurement (55% vs. 50%; difference, 5 percentage points [CI, 0 to 10 percentage points]).Limitations: Unmeasured residual differences in patient characteristics, a lower response rate in the national sample, and differences in documentation practices could have contributed to some of the observed differences.Conclusions: Patients from the VITA received higher-quality care according to a broad measure. Differences were greatest in areas where the VITA has established performance measures and actively monitors performance.