Improving Process Measurement

描述（由申请人提供）：本提案旨在改进过程测量，以便更好地评估医院的护理质量。离散过程度量，如CMS用于医院比较（HC）的离散过程度量，通常被医疗保健评估组织使用，因为它们：(1)快速收集（比传统的全局度量需要更少的抽象时间）；(2)易于理解并指出可能改进的提供者行为；(3)据称不需要调整严重性。事实上，利用过程度量的一个共同动机是相信这样的度量不需要严重性调整，除了粗略的包含和排除标准。这个应用程序检查了关于过程测量的两个基本问题：(1)是否进行离散过程测量，如CMS医院使用的那些，比较需求严重程度调整高于和超出常用的选择标准；(2)是否有其他可以利用的抽样方案，而不是典型的随机抽样（如CMS所做的），可以更好地（即，更有效和更少的偏差）在医院进行抽样处理，从而允许收集更多的全局过程措施，这些措施可能比医院比较中使用的离散措施与结果有更强的关联。我们提出了一个概念模型来研究过程测量的严重性调整的必要性，并在降低总体均方误差（MSE）的基础上比较各种过程测量方案：本研究将提出并提供一种基于多元匹配算法（我们称之为“多元模板匹配”）的可能更好的采样图表方法的初步数据，该算法可直接对患者进行标准化匹配，以便更好地选择医院内的患者，以比较各医院的护理过程。我们还将使用作为CMS医院比较计划的一部分收集的医疗保险数据集来检查流程措施，以(a)确定我们可以使用模板匹配算法实现出色的匹配；(b)使用模板匹配检验CMS用于医院比较的现有抽样方案是否减少了观察到的偏差。综上所述，我们将使用CMS授予我们特殊分析权限的数据集，在Hospital Compare中进行正式的偏倚测试，并通过Multivariate Template Matching正式测试更优的流程测量方案。如果成功，多元模板匹配将允许收集更详细的全局过程度量，因为抽象所需的样本大小（因此成本）可以减少。

DESCRIPTION (provided by applicant): This proposal aims to improve process measurement in order to better assess hospital quality of care. Discrete process measures like those used by CMS for Hospital Compare (HC) are commonly used by healthcare evaluation organizations because they are: (1) quick to collect (require less time in abstraction than traditional global measures); (2) easy to understand and point to potentially improvable provider actions; and (3) purportedly require no severity adjustment. In fact, a common motivation for utilizing process measurement is the belief that such measures do not require severity adjustment, beyond coarse inclusion and exclusion criteria. This application examines two fundamental questions regarding process measurement: (1) Do discrete process measures such as those utilized in CMS Hospital Compare need severity adjustment above and beyond the selection criteria commonly used; and (2) Are there other sampling schemes that could be utilized rather than typical random sampling (as is done by CMS) that could better (i.e., more efficiently and with less bias) sample processes at hospitals and therefore allow for the collection of more global process measures that could have stronger associations with outcomes than the discrete measures utilized in Hospital Compare. We present a conceptual model to study the need for severity adjustment for process measures and to compare various process measurement schemes based on reducing overall mean square error (MSE): This study will propose and present preliminary data on a potentially better method to sample charts for process measurement based on a multivariate matching algorithm we call "Multivariate Template Matching" which produces directly standardized matches of patients in order to better select patients inside hospitals to compare process of care across hospitals. We will also examine process measures using a Medicare data set collected as part of the CMS Hospital Compare initiative to (a) establish that we can achieve excellent matches using the Template Matching algorithm; and (b) test whether the bias observed with the present sampling schemes used by CMS for Hospital Compare is reduced using Template Matching. In summary, working with a data set to which CMS has given us special permission to analyze, we will formally test for bias in Hospital Compare, and formally test a more optimal scheme for conducting process measurement through Multivariate Template Matching. If successful, Multivariate Template Matching would allow for the collection of more detailed global process measures since the required sample size for abstraction (and therefore cost) could be reduced. PUBLIC HEALTH RELEVANCE: This application seeks to improve process measurement by (1) testing whether unadjusted process measures are biased because patient factors are associated with process adherence; and (2) developing a new methodology, Multivariate Template Matching, for more efficiently selecting patient charts in which to follow and compare process adherence. The application seeks to utilize a large database of process measure abstractions by CMS through the Hospital Compare project. If successful, results from this application could be utilized to implement template matching when assessing process compliance for Hospital Compare and other programs which study process as a quality of care indicator.