MEASURING EFFECTIVENESS OF CLINICAL MANAGEMENT SYSTEMS

该项目的总体目标是制定技术指标， 与临床管理系统相关的护理质量， 门诊病人建议与两个健康计划合作 （哈佛社区健康计划和亨利福特医疗保健公司在 底特律）开发方法来衡量12个临床 管理系统。将编制调查表并邮寄给 患者人群（1）已入组一年，（2）最近 访视，（3）近期实验室检查异常，（4）近期转诊 咨询，和/或（5）最近有慢性病就诊，询问 然后报告他们的经验与性能的选择 临床管理系统。对于同意参与的患者，计划 关于调查表中报告的相同事件的数据来源将 接受检查。每个患者问卷的数据将与 从计划来源的相关数据，以确定这两个来源是否同意， 是否（1）涉及十二个系统中的一个，（2）发生错误。 将构建系统错误率，以及它们的模式 探索事件使用计划数据作为黄金标准， 这些比率的分子和因子、敏感性、特异性和 将确定患者报告的预测值。的关系 将这些特性与患者的选定特征相结合， 他们的医疗保健，包括病人满意度的措施， 功能健康状况，将进行调查。费率将合并为 一套简短的指标，用于向计划提供反馈报告。成本 将评估这些报告的编制情况。

The overall goal of the project is to develop indicators of technical quality of care related to clinical management systems based an reports by ambulatory care patients. A collaboration is proposed with two health plans (Harvard Community Health Plan and Henry Ford Health Care Corporation in Detroit) to develop methods to measure performance of 12 clinical management systems. Questionnaires will be developed and mailed to populations of patients who (1) have been enrolled a year, (2) had a recent visit, (3) had a recent abnormal laboratory test, (4) had a recent referral for consultation, and/or (5) had a recent chronic disease visit, asking then to report on their experiences with the performance of the selected clinical management systems. For patients who agree to participate, plan data sources concerning the same events reported in the questionnaires will be examined. Data from each patient questionnaire will be matched to the related data from plan sources to determine if these two sources agree an whether (1) one of the twelve systems was involved, (2) an error occurred. Rates of system errors will be constructed, and their patterns of occurrence explored. Using the plan data as the gold standard for both numerators and denominators of these rates, sensitivity, specificity and predictive value of patient reports will be determined. The relationship of these properties to selected characteristics of the patients and of their health care, including measures of patient satisfaction and functional health status, will be investigated. Rates will be combined into a short set of indicators to provide feedback reports to plans. Costs of production of these reports will be assessed.