Quality of care for patients with rheumatoid arthritis
Quality of care for patients with rheumatoid arthritis
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DOI：
10.1001/jama.284.8.984
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发表时间：
2000-08-23
影响因子：
120.7
通讯作者：
Shekelle, PG
中科院分区：
文献类型：
--
作者：
MacLean, CH;Louie, R;Shekelle, PG
背景：类风湿关节炎患者由于其关节炎和因合并症引起的过早死亡而有大量发病率的风险。然而，人们对这些病人接受的医疗保健质量知之甚少。目的评价类风湿关节炎患者的关节炎、合并症和保健护理的质量，探讨专科护理模式对质量的影响。设计、环境和参与者对1355名成年类风湿性关节炎患者进行了历史队列研究，这些患者参加了美国一家全国性保险公司的按服务收费或按服务折扣收费计划，在1991年至1995年期间通过管理数据对患者进行了识别和随访。主要结果测量关节炎、合并症和保健维护的质量评分是根据与这些领域相关的明确过程测量的表现得出的，并描述了在研究的每个人年期间每个领域内执行的指示卫生保健过程的百分比。结果在4598人年的随访中，关节炎护理的质量评分为62%(95%可信区间[CI]， 61%-64%)，合并症护理的质量评分为52% (95% CI, 49%-55%)，健康护理维持的质量评分为42% （95% CI, 40%-43%）。在各个领域，包括相关专家在内的护理模式的绩效得分比不包括相关专家的护理模式的绩效得分高出30%至187%
Context Patients with rheumatoid arthritis are at risk for substantial morbidity because of their arthritis and premature mortality due to comorbid diseases. However, little is known about the quality of the health care that these patients receive.Objective To assess the quality of the health care that rheumatoid arthritis patients receive for their arthritis, comorbid diseases, and health care maintenance and to determine the effect of patterns of specialty care on quality.Design, Setting, and Participants Historical cohort study of 1355 adult rheumatoid arthritis patients en rolled in the fee-for-service or discounted fee-for-service plans of a nationwide US insurance company, Patients were identified and followed up through administrative data between 1991 and 1995.Main Outcome Measures Quality scores for arthritis, comorbid disease, and health care maintenance were developed from performance on explicit process measures that related to each of these domains and described the percentage of indicated health care processes performed within each domain during each person-year of the study.Results During 4598 person-years of follow-up, quality scores were 62% (95% confidence interval [CI], 61%-64%) for arthritis care, 52% (95% CI, 49%-55%) for comorbid disease care, and 42% (95% CI, 40%-43%) for health care maintenance. Across domains, care patterns including relevant specialists yielded performance scores 30% to 187% higher than those that did not (P