Health equity monitoring for healthcare quality assurance
Health equity monitoring for healthcare quality assurance
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DOI：
10.1016/j.socscimed.2018.01.004
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发表时间：
2018-02-01
影响因子：
5.4
通讯作者：
Goldblatt, P.
中科院分区：
文献类型：
--
作者：
Cookson, R.;Asaria, M.;Goldblatt, P.
全民健康公平监测仍然孤立于主流的医疗质量保证之外。因此，尽管医疗保健组织对普通患者的护理质量越来越了解，但他们仍然不了解其决策对健康公平的影响。我们提出了一种新的和改进的分析方法，将健康公平纳入主流医疗保健质量保证，说明了这种方法如何在英国国民健康服务中应用，并讨论了如何在其他国家应用它。我们使用一个关键的质量指标来说明这种方法，该指标被广泛用于评估初级、社区和急性环境之间的医疗保健协调程度：门诊护理敏感慢性疾病的紧急住院患者入院（简称“潜在可避免的急诊入院”）。2015年英格兰可避免急诊入院的整体人口数据与邻里剥夺指数有关。209个临床委托小组（ccg：平均人口为272,000的医疗采购组织）所服务的人群中的不平等与两个基准进行了比较-国家不平等和10个类似人群中的不平等-使用社区水平模型模拟大多数和最不贫困社区之间间接标准化入院的差距。英国模拟的不平等差距是每10万人中有927人可能可以避免急诊入院，这意味着与不平等相关的263,894例超额住院。与这个国家基准相比，17%的ccg的股本明显低于基准，23%的ccg明显好于基准。与同类人口基准相比，相应的数字分别为11%和12%。在为相似人群服务的英语ccg之间，与潜在可避免的紧急入院有关的剥夺不平等存在很大差异，超出了预期的统计差异。关于不同医疗机构服务的相似人群中医疗质量不平等的管理数据可以为医疗质量保证提供有用的信息。
Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions - despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions ("potentially avoidable emergency admissions", for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks - national inequality and inequality within ten similar populations - using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical variation. Administrative data on inequality in healthcare quality within similar populations served by different healthcare organizations can provide useful information for healthcare quality assurance.