Inconsistent report cards - Assessing the comparability of various measures of the quality of ambulatory care
Inconsistent report cards - Assessing the comparability of various measures of the quality of ambulatory care
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DOI：
10.1097/00005650-200202000-00010
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发表时间：
2002-02-01
期刊：
影响因子：
3
通讯作者：
Brennan, TA
中科院分区：
文献类型：
--
作者：
Gandhi, TK;Cook, EF;Brennan, TA
背景基于各种绩效指标的报告卡越来越普遍地用于对医院和医疗保健计划进行评级。然而，在门诊一级几乎没有做任何工作来制作报告卡，也没有对报告卡的潜在组成部分进行太多的比较。根据不同的数据收集方法为门诊创建一个报告卡，并评估不同质量领域的门诊评分之间的相关性。横断面图表审查（n = 3614）、患者（n = 2180）和医生调查（n = 169）。从1996年5月至1997年6月，波士顿地区11个门诊诊所的20至75岁的门诊患者及其初级保健提供者的样本。每个站点在各种质量指标上的表现。为每个研究中心创建了五个质量领域的报告卡评分（HEDIS类指标、诊所功能、患者满意度、糖尿病指南依从性、哮喘指南依从性）。这五个领域的得分都与其他领域的得分没有显著相关性。此外，与所有诊所的相应平均领域评分相比，领域评分存在显著的临床内差异。通过将指标限制为仅在图表审查或调查中发现的指标，创建了额外的临床领域评分。每个诊所的病历审查和调查领域得分也没有显著相关性。只强调一个质量领域或使用有限的数据收集方法的报告卡可能会向医疗保健消费者提供关于门诊诊所整体质量的不完整或不一致的信息。
BACKGROUND. Report cards based on various performance measures have become increasingly common for rating hospitals and health care plans. However, little has been done to create report cards at the ambulatory clinic level, nor has there been much comparison of the potential components of report cards.OBJECTIVES. To create a report card for ambulatory clinics based on different data collection methods and to assess the correlations of clinic scores across various domains of quality.RESEARCH DESIGN. Cross-sectional chart review (n = 3614), patient (n = 2180), and physician surveys (n = 169).SUBJECTS. Sample of outpatients ages 20 to 75 and their primary care providers in 11 ambulatory clinic sites in the Boston-area from May 1996 to June 1997.MEASURES. Performance on various quality indicators for each site.RESULTS. Report card scores for five quality domains (performance on HEDIS-like measures, clinic function, patient satisfaction, diabetes guideline compliance, asthma guideline compliance) were created for each site. None of the five domain scores were significantly correlated with any of the other domains. In addition, there was substantial intraclinic variation in domain scores when compared with the corresponding mean domain score across all clinics. Additional clinic domain scores were created by limiting measures to those found on chart review or survey alone. The chart review and survey domain scores for each clinic were also not significantly correlated.CONCLUSIONS. Report cards that emphasize only one domain of quality or use limited data collection methods may provide incomplete or inconsistent information to health care consumers about the overall quality of an outpatient clinic.