Case-Mix Adjustment of the Bereaved Family Survey
Case-Mix Adjustment of the Bereaved Family Survey
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DOI：
10.1177/1049909117752669
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发表时间：
2018-07-01
影响因子：
1.9
通讯作者：
Ersek, Mary
中科院分区：
文献类型：
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作者：
Kutney-Lee, Ann;Carpenter, Joan;Ersek, Mary
对丧失亲人的家庭成员的调查越来越多地被用来评估临终关怀和衡量临终关怀质量的组织绩效。丧失亲人家庭调查（BFS）用于监测退伍军人事务部（VA）卫生保健系统的EOL护理质量和基准绩效。本研究的目的是开发一个病例组合调整模型的BFS和检查调整后的设施水平的分数变化，以提供公平的比较设施。我们对来自146个VA医疗中心的退伍军人及其家庭成员的医疗记录和调查数据进行了横断面二次分析。使用基于模型的倾向加权进行调整后，各机构的BFS-性能指标评分的平均变化为-0.6，范围为-2.6至0.6。55个（38%）设施在其未调整分数的+/- 0.5个百分点内变化。平均而言，从调整中受益最多的设施照顾的是负担更重的病人，位于该国西北和中西部地区的城市地区。病例组合调整导致机构级BFS评分发生微小变化，但允许对EOL护理质量进行更公平的比较。BFS的病例组合调整将这一国家质量论坛认可的措施用于VA领导的公开报告和内部质量仪表板，并可能为其他丧亲家庭成员调查的病例组合调整模型的开发和完善提供信息。
Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within +/- 0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.