Measuring quality of care for people with Mulitple Chronic Conditions

描述（由申请人提供）：患有多种慢性疾病（MCC）的人群数量庞大，而且还在不断增长，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，目前还没有专门为MCC患者或人群设计的护理质量标准、指南或措施。例如，现有的特定疾病目标和指标可能会激励低效率的护理提供，并有可能产生意想不到的不良后果，标准预防指南可能需要根据发病率负担进行修改。有很多人呼吁制定和实施与慢性病相关的指标，这些指标可以在人群层面上使用，以促进以患者为中心的MCC护理方法。我们将开发和评估MCC患者护理质量的初步综合衡量标准。这种“MCC质量复合材料”将以电子数据为基础，并适用于各种条件。它将增强我们对如何为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，以改善现实环境中的MCC护理；b)展示系统和临床医生改善MCC护理的可操作领域；c)为未来MCC质量指标发展奠定基础；d)引入常规评估MCC护理质量的概念。拟议的项目将利用一个独特的数据基础设施，系统地收集患者报告数据、丰富的临床数据和医疗计划管理数据，这些数据来自44,000多名MCC医疗保险受益人的综合交付系统。我们将使用改进的德尔菲过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通过评估医院使用率和患者体验作为测量函数，并描述与接受高质量MCC护理相关的患者水平特征来评估MCC复合。拟议项目的成功完成将改善对老年人和慢性病患者等AHRQ优先人群的护理；并将解决美国卫生与公众服务部（HHS）关于MCC的倡议的目标，即“确定、制定、认可和使用关键质量指标，以绩效衡量的形式，促进MCC患者一般护理的最佳做法”。

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."