Defining Multiple Chronic Conditions for Quality Measurement
Defining Multiple Chronic Conditions for Quality Measurement
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DOI：
10.1097/mlr.0000000000000853
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发表时间：
2018-02-01
期刊：
影响因子：
3
通讯作者：
Lin, Zhenqiu
中科院分区：
文献类型：
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作者：
Drye, Elizabeth E.;Altaf, Faseeha K.;Lin, Zhenqiu
背景/目的：多重慢性疾病（MCCs）患者是质量测量的一个关键但未定义的群体。我们提出了一种普遍适用的系统方法来定义医疗保险按服务收费受益人的MCC队列，我们为负责任的医疗机构开发了一种国家质量衡量标准，即风险标准化的计划外入院率。研究设计：为了确定MCC队列，我们：(1)确定潜在的慢性疾病；(2)基于MCC框架和测量概念制定队列条件标准；(3)采用实证分析、专家和公众提供的标准；(4)描述更广泛和更狭窄的队列；(5)选择有利益相关者输入的最终队列。研究对象：研究对象为慢性疾病患者。参与者包括2180万2012年65岁及以上的医疗保险按服务收费受益人，27个医疗保险慢性疾病仓储条件中有1个。结果：根据我们的标准，总共确定了10种慢性疾病；这10例中有8例同时发生时入院风险显著增加。更广泛的队列（8个条件中的2个以上）包括490万受益人（占总队列的23%），录取率为每100人年70人。它占据了总录取人数的53%。较窄的队列（3+条件）有220万受益人（10%），每100人年有100人入院，占入院人数的32%。大多数利益相关者认为更广泛的队列最符合度量概念。结论：通过系统地将慢性疾病缩小到与结果最相关的疾病，并纳入利益相关者的意见，我们定义了一个由利益相关者支持的MCC入院测量队列。这种方法可以作为其他MCC结果测量的模型。
Background/Objective:Patients with multiple chronic conditions (MCCs) are a critical but undefined group for quality measurement. We present a generally applicable systematic approach to defining an MCC cohort of Medicare fee-for-service beneficiaries that we developed for a national quality measure, risk-standardized rates of unplanned admissions for Accountable Care Organizations.Research Design:To define the MCC cohort we: (1) identified potential chronic conditions; (2) set criteria for cohort conditions based on MCC framework and measure concept; (3) applied the criteria informed by empirical analysis, experts, and the public; (4) described broader and narrower cohorts; and (5) selected final cohort with stakeholder input.Subjects:Subjects were patients with chronic conditions. Participants included 21.8 million Medicare fee-for-service beneficiaries in 2012 aged 65 years and above with 1 of 27 Medicare Chronic Condition Warehouse condition(s).Results:In total, 10 chronic conditions were identified based on our criteria; 8 of these 10 were associated with notably increased admission risk when co-occurring. A broader cohort (2+ of the 8 conditions) included 4.9 million beneficiaries (23% of total cohort) with an admission rate of 70 per 100 person-years. It captured 53% of total admissions. The narrower cohort (3+ conditions) had 2.2 million beneficiaries (10%) with 100 admissions per 100 person-years and captured 32% of admissions. Most stakeholders viewed the broader cohort as best aligned with the measure concept.Conclusions:By systematically narrowing chronic conditions to those most relevant to the outcome and incorporating stakeholder input, we defined an MCC admission measure cohort supported by stakeholders. This approach can be used as a model for other MCC outcome measures.