Crossing the Quality Assessment Chasm: Aligning Measured and True Quality of Care

跨越质量评估鸿沟：使衡量的护理质量与真实的护理质量保持一致

基本信息

批准号：
7500204
负责人：
MARK G WEINER
金额：
$ 45.96万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-30 至 2010-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7500204
关键词：
Crossing Quality Assessment Chasm Aligning

项目摘要

DESCRIPTION (Provided by the Applicant): Diabetes control within an ambulatory setting has many long-term benefits, including the minimization of morbidity and mortality often associated with the disease. Several studies have established and validated the importance of an aggressive approach to treatment for patients with type I and Type II diabetes. These studies measured improvement in diabetes control by comparing the year-to-year average of HBA1c values in an intensively treated group with the values among a traditionally treated group. Quality of care was assessed using a comparison of cross sectional averages of HBA1c in the two populations over time. In research settings it was fitting to use this cross sectional approach to quality improvement. However, most patient care settings are not as well monitored or controlled as these research studies. As a result, the translation of these measures of quality into actual practice is not simple. Using a cross sectional approach to quality assessment in what is, inherently, a longitudinal disease in a heterogeneous population is flawed. The purpose of this study is to identify and quantify the impact on quality assessment of real-world circumstances where the current cross sectional measures of quality do not reflect the true quality of care being rendered. It will leverage more detailed and discrete data available from electronic medical records in order to develop measures that account for heterogeneity among different diabetic patient panels, credit improvement in the control of diabetes among individuals in a given population over time, recognize provider effort in medical management, and incorporate management of diabetes co-morbidities such as high blood pressure and hyperlipidemia. The result of the analysis will help to create a new set of quality measures that is more consistent with actual clinical care. The aims of the study are as follows: 1. Evaluate structural and clinical issues that may affect the validity of comparisons among providers made using quality measures for diabetes. Among the issues to be explored are a) the manner in which diabetes is defined; b) the way patients are linked to providers, and c) the concordance between use of diabetes medications and achieving thresholds for quality of care. 2. Develop a new quality measure for diabetes that accounts for patient heterogeneity in terms of baseline HBA1c and expected trajectory of improvement in diabetes control based on clinical parameters and other data available through the EHR 3. Explore the DCCT and patient data for year to year individual variability in diabetes control to assess the impact of variability in an individual's diabetes control over time on microvascular outcomes. 4. Disseminate findings through public policy communications through the Leonard Davis Institute and work with practitioners and additional institutions to assess their quality of care under the old and proposed new quality of care measures.

描述（由申请人提供）：卧床环境中的糖尿病控制具有许多长期益处，包括最小化发病率和与疾病有关的死亡率。几项研究已经确定并验证了对I型和II型糖尿病患者进行侵略性治疗方法的重要性。这些研究通过比较了经过二等处理的组中HbA1c值的年平均值与传统治疗组中的值，从而衡量了糖尿病控制的改善。随着时间的流逝，使用两个人群中HBA1C的横截面平均值进行了比较，评估了护理质量。在研究环境中，使用这种横截面方法进行质量改进是合适的。但是，大多数患者护理环境的监测或控制不如这些研究。结果，将这些质量度量指标转化为实际实践并不简单。使用横截面方法来质量评估，从本质上讲，在异质种群中的纵向疾病是有缺陷的。这项研究的目的是识别和量化对现实世界质量评估的影响当前质量测量的情况并不能反映出所提供的护理的真正质量。它将利用从电子病历中获得的更详细和更离散的数据，以制定衡量不同糖尿病患者面板中异质性的措施，随着时间的推移，给定人群中个体糖尿病的控制的信用提高，认识到医疗管理方面的提供者努力，并在糖尿病管理中融合了糖尿病，例如高血压和高血压和超级血压和超级liplipipidemia。分析的结果将有助于创建一套与实际临床护理更一致的新质量度量。该研究的目的如下： 1。评估可能影响提供者比较有效性的结构和临床问题使用糖尿病的质量措施制成。在要探讨的问题中有a）定义了哪些糖尿病； b）患者与提供者链接的方式，c）一致性在使用糖尿病药物和达到护理质量的阈值之间。 2。针对糖尿病制定新的质量措施基线HBA1C和基于临床糖尿病控制改善的预期轨迹通过EHR获得的参数和其他数据 3。探索糖尿病控制中年度变异性的DCCT和患者数据以评估随着时间的流逝，个人糖尿病中变异性的影响对微血管结局的影响。 4。通过伦纳德·戴维斯研究所（Leonard Davis Institute）通过公共政策通讯传播调查结果与从业人员和其他机构合作，以评估其旧的护理质量提出了新的护理质量措施。