QUALITY DIFFERERNCES AMONG PRIMARY CARE PRACTITIONERS

解决改善门诊医疗护理需求的一种方法是 确定哪些因素可以预测性能质量的变化 实践者和实践场所之间的关系。 确定预测因素 质量将指导对提高质量的干预措施的选择。 我们建议利用现有的数据库，涉及800多个 16个实践小组的实践者，以测试一系列假设， 初级保健从业人员之间的护理质量差异。 此数据 进行了基本的详细图表审查，以衡量是否符合 在乎 将检查两种性能： 儿童和成人的医疗条件，以及在这些相同的性能 随机质量保证干预后的条件。 我们将研究有关以下方面的具体预测 关系：（1）从业者角色的影响（工作人员医生， 居民，非医生卫生专业人员）， 特定的功能，以及从业者在多大程度上表现得更好 女性病人的护理任务 (2)的程度 从业者在其他任务上的表现预测了在给定任务上的表现。 任务，并在多大程度上改善给定的任务以下质量 保证可以通过其他任务的改进和基线来预测 性能 (3)在多大程度上，组长的业绩和 他/她对质量保证预测的响应性能变化 小组成员的业绩和业绩变化，以及 这种影响的程度取决于从业者的水平 融入了集团。 (4)在多大程度上， 组中的从业者，以及从业者的相对工作份额 对于给定的任务，预测质量保证后的性能变化。 (5)质量保证后性能变化的程度 由从业者对质量保证的态度预测 干预措施。

One way to adress the need to improve ambulatory medical care is to ascertain what factors can predict variations in performance quality between practitioners and practice sites. Identifying predictors of quality will guide the choice of interventions to increase quality. We propose to utilize an existing data base involving over 800 practitioners in 16 practice groups to test a series of hypotheses about quality of care differences among primary care practitioners. In this data base, detailed chart review was done to measure conformity to standards of care. Two kinds of performance will be examined: performance for eight pediatric and adult medical conditions, and performance on these same conditions following a randomized quality assurance intervention. We will investigate specific predictions concerning the following relationships: (1) The effect of practitioner role (staff physician, resident, non-physician health professional) upon the performance of particular functions, and the extent to which practitioners perform better on female-related patient care tasks. (2) The extent to which practitioners' performance on other tasks predicts performance on a given task, and the extent to which improvement on a given task following quality assurance can be predicted by improvements on other tasks and by baseline performance. (3) The extent to which the group leader's performance and his/her change in performance in response to quality assurance predicts performance and change in performance by members of the group, and the extent to which this effect depends on how well a practitioner is intergrated into the group. (4) The extent to which the number of practitioners in the group, and the relative work-share of a practitioner for a given task, predicts change in performance after quality assurance. (5) The extent to which change in performance after quality assurance is predicted by the practitioner's attitudes toward quality assurance interventions.