Do cardiology quality measures actually improve patient outcomes?
Do cardiology quality measures actually improve patient outcomes?
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DOI：
10.1161/jaha.113.000404
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发表时间：
2014-02-07
影响因子：
5.4
通讯作者：
Joynt KE
中科院分区：
文献类型：
--
作者：
Chatterjee P;Joynt KE
在过去的三十年里，住院患者的心血管质量指标经历了快速的演变。单纯测量质量的孤立努力已经发展成为致力于公开报告医院在一些质量指标上的表现的国家计划。最近，质量指标的表现已变得与医院和医生的报酬密切相关。随着《平价医疗法案》(ACA)的实施，我们衡量、报告和支付优质医疗服务的方式将在未来几年继续发生进一步的变化。心血管护理中的质量措施的核心是提高向患者提供的护理质量，并通过这样做来改善与患者相关的结果，如死亡率、再次住院和患者体验。然而，质量措施和硬结果之间的关系一直不一致，因此，对于旨在利用这些措施有效推动心血管护理改善的政策制定者和临床领导者来说，这是有问题的。在这篇综述中，我们研究了三种主要的质量改进机制背后的证据：单独测量、公开报告和按绩效付费。在描述作为这些机制的一部分而发生的成功和失败的过程中，我们提供了一个框架来为未来的质量改进工作提供信息。
Cardiovascular quality measures for inpatient care have undergone a rapid evolution over the past three decades. Isolated efforts at simply measuring quality have developed into national programs dedicated toward the public reporting of hospital performance on a number of quality measures. Most recently, performance on quality measures has become closely tied to hospital and physician payments. With the implementation of the Affordable Care Act (ACA), further changes in how we measure, report, and pay for quality health care will continue in coming years. At their core, quality measures in cardiovascular care are meant to improve the quality of care delivered to patients, and in doing so, improve patient-relevant outcomes such as mortality, hospital readmission, and patient experience. However, the relationship between quality measures and hard outcomes has been inconsistent, and thus, problematic for policymakers and clinical leaders who aim to use these measures to effectively drive improvements in cardiovascular care. In this review, we examine the evidence behind three major mechanisms of quality improvement: measurement alone, public reporting, and pay-for-performance. In characterizing the successes and failures that have occurred as part of each of these mechanisms, we provide a framework to inform future quality improvement efforts.