EVALUATING QUALITY IMPROVEMENT STRATEGIES

尽管购买者、监管机构和倡导者对医疗服务提供机构施加了相当大的压力，以提高医疗服务的质量，但几乎没有严格证明质量改进(QI)的方法可以改善医疗服务。尤其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。我们建议利用波士顿综合交付系统中计划启动的儿童哮喘疾病管理计划，在同一系统中的不同实践中同时实施基于办公室的QI策略，并通过随机设计评估它们在改善护理过程和结果方面的相对有效性和成本效益。在每项干预措施实施一年后，我们将为实践提供补充干预措施，以确定每种方法提供的边际收益和成本。数据将从父母电话调查、提供者调查和计算机化索赔数据库中获得，这些数据针对综合交付系统中由三个大型管理保健组织之一覆盖的哮喘儿童。这项研究的具体目标是：1.在大型管理保健组织中建立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、保健结果和保健费用；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.