The effect of multiple-facility visiting by patients on quality of care assessment

虽然护理质量评估的过程往往发生在一个设施的基础上，在管理慢性疾病，如癌症，病人往往在多个设施接受治疗。如果其他机构提供的治疗缺失，此类患者就诊模式可能会影响观察到的表现评分。本研究使用从保险公司获得的保险索赔数据，其中患者可以追溯到多个设施的访问，并分析了患者访问多个设施对质量评分的影响。例如，我们发现，乳腺癌保乳手术后放射治疗的表现存在14个百分点的差异，这是护理领域的一个典型质量标准。当我们衡量护理质量时，应该对在多个设施接受护理的患者给予足够的关注。

Although process of care quality assessment often take place on a facility basis, in a management chronic illness such as cancer, patients often receive treatment in multiple facilities. Such patient visit patterns can affect observed performance score if the treatment provided in other facilities are missing. This study used insurance claims data obtained from insurance companies, in which patients can be traced for visits to multiple facilities, and analyzed the influence of patients' visiting multiple facilities on the quality scores. We found, for example, a 14 percentage-point difference on a performance of radiation therapy after breast conserving surgery for breast cancer, a typical quality criteria in the area of care. When we measure quality of care, enough attention should be paid to patients receiving care in multiple facilities.