Quality assessment: is the focus on providers or on patients?
Quality assessment: is the focus on providers or on patients?
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质量评估：重点是提供者还是患者？
DOI：
10.1093/intqhc/8.3.231
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Weiner,JP
中科院分区：
文献类型：
--
作者：
Scholle,SH;Bernier,J;Starfield,B;Powe,NR;Weiner,JP
大多数关于门诊护理质量的研究都是基于对单一环境中护理事件的图表审查，而不是基于患者随时间和跨环境接受的护理。本研究的目的是比较门诊护理质量分数的基础上，从通常的护理来源的信息，分数的基础上，在一年内看到的所有供应商的信息。对1988年连续参加马里兰州医疗补助计划的55名2岁儿童和70名儿童和成人的哮喘护理质量进行了评估。对于良好的儿童保育，质量分数普遍提高，因为有更多的机会执行理想的行动，如铅筛选。然而，哮喘护理的质量评分普遍下降，因为不受欢迎的临床医生的行动，如未能记录的后续计划，增加了更多的问题被发现。因此，质量评估的结果根据重点是个别提供者提供的护理还是病人接受的护理而有所不同。差异的方向将取决于质量指标是否代表建议的护理或不当护理的疏忽。版权所有© 1996爱思唯尔科技有限公司
Most studies of ambulatory care quality are based on chart reviews of episodes of care in single settings, rather than on care received by a patient over time and across settings. The purpose of this study was to compare ambulatory care quality scores based on information from the usual source of care to scores based on information from all providers seen during a year. The quality of well child care for 55 two-year-olds and asthma care for 70 children and adults continuously enrolled in the Maryland Medicaid program throughout 1988 was assessed.Combining data from multiple providers changed quality scores in both directions. For well child care, quality scores generally improved because of an increased opportunity to perform desirable actions, such as lead screening. However, quality scores for asthma care generally decreased because undesirable clinician actions, such as the failure to document follow-up plans, increased as more problems were uncovered. Thus, the findings of quality assessments differ according to whether the focus is on care delivered by individual providers or on care received by patients. The direction of the difference will depend upon whether the indicators of quality represent omission of recommended care or commission of improper care. Copyright © 1996 Elsevier Science Ltd.