Measuring quality of care for people with Mulitple Chronic Conditions

衡量多种慢性病患者的护理质量

• 批准号: 8726014
• 负责人: ELIZABETH A BAYLISS
• 金额: $ 17.93万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2016-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8726014
• 关键词: Measuring; quality; care; people; Mulitple

DESCRIPTION (provided by applicant): The population of persons with multiple chronic conditions (MCC) is large, growing, and consumes a disproportionate share of healthcare resources. It is well recognized that we need to optimize care for this population. However, there are no existing standards, guidelines, or measures of care quality designed specifically for MCC patients or populations. For example, existing disease-specific goals and metrics may incentivize inefficient care delivery and risk adverse unintended consequences, and standard prevention guidelines may need to be altered based on morbidity burden. There have multiple calls to develop and implement metrics that are relevant across chronic conditions and can be used on a population level to promote patient-centered approaches to MCC care. We will develop and evaluate a preliminary composite measure of care quality for populations with MCC. This 'MCC quality composite' will be based on electronically available data and will be applicable across conditions. It will enhance our understanding of how to provide high quality health care for patients with MCC by: a) permitting evaluation of system-level interventions to improve MCC care in real-world settings, b) demonstrating actionable areas for systems and clinicians to improve MCC care, c) establishing a basis for future MCC quality metric development, and d) introducing the concept of routine evaluation of MCC care quality. The proposed project will take advantage of a unique data infrastructure of systematically collected patient- reported data, rich clinical data, and health plan administrative data on over 44,000 Medicare beneficiaries with MCC in an integrated delivery system. We will use a modified Delphi process to enhance and refine a list of measure components. We will then use multivariable modeling to evaluate the MCC composite by assessing hospital utilization and patient experience as a function of the measure, and describing patient-level characteristics associated with receipt of high quality MCC care. Successful completion of the proposed project will improve care for the AHRQ priority populations of the elderly and persons with chronic illness; and will address the goal of the US Department of Health and Human Services (HHS) initiative on MCC to "identify, develop, endorse, and use key quality metrics, in the form of performance measures, to promote best practices in the general care of individuals with MCC."

描述（由申请人提供）：患有多种慢性病 (MCC) 的人群数量庞大且不断增长，并且消耗了不成比例的医疗资源。众所周知，我们需要优化对这一人群的护理。然而，目前还没有专为 MCC 患者或人群设计的护理质量标准、指南或措施。例如，现有的针对特定疾病的目标和指标可能会导致护理服务效率低下，并可能带来意想不到的不良后果，并且可能需要根据发病负担来改变标准预防指南。人们多次呼吁制定和实施与慢性病相关的指标，并可在人群层面上使用，以促进以患者为中心的 MCC 护理方法。我们将制定并评估 MCC 人群护理质量的初步综合衡量标准。该“MCC 质量综合报告”将基于电子可用数据，并且适用于各种条件。它将通过以下方式增强我们对如何为 MCC 患者提供高质量医疗保健的理解：a) 允许评估系统级干预措施，以改善现实世界中的 MCC 护理；b) 为系统和临床医生展示改善 MCC 护理的可操作领域；c) 为未来 MCC 质量指标的制定奠定基础；d) 引入 MCC 护理质量常规评估的概念。拟议项目将利用独特的数据基础设施，在集成交付系统中系统收集患者报告数据、丰富的临床数据以及超过 44,000 名 MCC 医疗保险受益人的健康计划管理数据。我们将使用修改后的 Delphi 流程来增强和细化度量组件列表。然后，我们将使用多变量模型来评估 MCC 组合，通过评估医院利用率和患者体验作为测量的函数，并描述与接受高质量 MCC 护理相关的患者水平特征。拟议项目的成功完成将改善对 AHRQ 优先人群（老年人和慢性病患者）的护理；并将实现美国卫生与公众服务部 (HHS) 关于 MCC 倡议的目标，即“以绩效衡量的形式确定、制定、认可和使用关键质量指标，以促进 MCC 患者一般护理的最佳实践。”