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

描述（由申请人提供）：在门诊环境中控制糖尿病具有许多长期益处，包括最大限度地降低通常与该疾病相关的发病率和死亡率。几项研究已经确立并验证了积极治疗I型和II型糖尿病患者的重要性。这些研究通过比较强化治疗组与传统治疗组的HBA 1c值的年平均值来衡量糖尿病控制的改善。通过比较两个人群随时间推移的HBA 1c横截面平均值来评估护理质量。在研究环境中，使用这种横截面方法来提高质量是合适的。然而，大多数患者护理环境没有像这些研究那样得到很好的监测或控制。因此，将这些质量衡量标准转化为实际做法并不简单。在异质性人群中使用横断面方法进行质量评估本质上是纵向疾病，这是有缺陷的。 本研究的目的是确定和量化的影响，质量评估的现实世界 目前的横向质量衡量标准不能反映所提供护理的真实质量的情况。它将利用电子医疗记录中提供的更详细和离散的数据，以制定措施，说明不同糖尿病患者小组之间的异质性，随着时间的推移，在给定人群中个人控制糖尿病的信用改善，认可医疗管理提供者的努力，并纳入糖尿病合并症的管理，如高血压和高脂血症。分析的结果将有助于创建一套新的质量措施，更符合实际的临床护理。这项研究的目的如下： 1.评估可能影响供应商之间比较有效性的结构和临床问题 使用糖尿病的质量措施。需要探讨的问题包括：（a） 糖尿病的定义; B）患者与提供者的联系方式，以及c）一致性 使用糖尿病药物和达到护理质量阈值之间的关系。 2.开发一种新的糖尿病质量测量方法，该方法在以下方面考虑了患者异质性： 基线HbA 1c和基于临床的糖尿病控制的预期改善轨迹 通过EHR提供的参数和其他数据 3.探索DCCT和患者数据，以评估糖尿病控制的年度个体差异 个体糖尿病控制随时间变化对微血管结局的影响。 4.通过伦纳德戴维斯研究所的公共政策交流传播研究结果， 与从业人员和其他机构合作，评估他们在老年人和 提出了新的护理质量措施。

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.