EVALUATING QUALITY IMPROVEMENT STRATEGIES

虽然购买者，监管机构和倡导者施加相当大的压力，医疗机构提高医疗服务的质量，质量改进（QI）的方法已被严格证明，以改善护理。 特别需要关于改善门诊护理的不同方法的相对有效性和成本效益的信息。我们建议利用计划启动的疾病管理计划的儿童哮喘在波士顿为基础的综合交付系统，同时实施办公室为基础的QI战略在同一系统中的不同做法，并通过随机设计评估其相对有效性和成本效益，在改善护理过程和结果。 在每种干预措施实施一年后，我们将提供补充干预措施，以确定每种方法提供的边际效益和成本。 数据将来自家长电话调查，提供者调查和计算机化的索赔数据库，这些儿童在综合交付系统与哮喘谁是由三个大型管理式医疗机构之一。本研究的具体目的是：1.在一个大型的管理式医疗机构中建立一个基于实践的质量改进计划，2.确定该策略与针对高成本患者的疾病管理策略相比，如何影响哮喘儿童的特定护理过程、医疗保健结果和医疗保健成本;以及3.评估这两种方法的相对成本效益。

Although purchasers, regulators, and advocates exert considerable pressure on care delivery organizations to improve the quality of health care services, few approaches to quality improvement (QI) have been rigorously demonstrated to improve care. Information is particularly needed on the relative effectiveness and cost- effectiveness of different approaches to improving outpatient care. We propose to take advantage of the planned initiation of a disease management program for childhood asthma in a Boston-based integrated delivery system by simultaneously implementing an office-based QI strategy in different practices in the same system, and to assess via a randomized design their relative effectiveness and cost-effectiveness in improving processes and outcomes of care. After each intervention has been in place for one year, we will offer the complementary intervention to the practice, to determine the marginal benefits and costs that each approach offers. Data will be derived from a parent telephone survey, a provider survey and a computerized claims databases for those children in the integrated delivery system with asthma who are covered by one of three large managed care organizations. The specific aims of the study are to: 1. establish a practice based quality improvement program in a large managed care organization, 2. determine how this strategy, when compared with a disease management strategy that targets high cost patients, affects specified processes of care, health care outcomes, and health care costs for children with asthma, and 3. assess the relative cost-effectiveness of these two approaches.