PATIENT-BASED QUALITY ASSESSMENT FOR CHRONIC DISEASE

目前正在制定的总体护理质量衡量标准和 参与国家质量倡议，如NCQA、FACCT、JACHO和 其他组织，主要是为普通民众设计的 由健康计划提供服务，或者，如果专注于特定疾病，则依赖于 将病历作为主要数据来源。对调查的兴趣 捕获其他来源中未包含的信息，或补充 或取代更昂贵、更不可靠的索赔和医疗保险 记录正在增加。除了费用，医疗记录不是 足以评估计划执行情况的某些关键指标，如 患者对健康计划、人际护理质量的满意度， 或一般的或针对特定情况的患者感知的护理结果。 我们编制了一份包含综合素质的调查问卷 对哮喘、糖尿病三种常见慢性病患者的应对措施 还有腰部疼痛。这项旨在比较医疗计划的调查， 派生出这些一般的和特定于条件的度量的大部分 从那些为AHCPR赞助的港口开发的3个指数 条件。在全国范围内对这份问卷进行了现场测试， 分布在6个主要地理位置的39个医疗计划中的12,000名患者 大都市区，1997年8月完成，初步分析 这4000名患有这三种指征之一的患者建议 这些针对疾病的质量指标在 与一般措施相比，对健康计划的区别更大。我们 建议进行全面的敏感性测试。 健康计划比较中针对疾病的质量衡量标准，以及 使用索赔数据，以验证许多这些基于患者的衡量标准 疾病特有的进程和健康结果。这份提案提供了 对糖尿病患者开发的措施和方法进行了严格的现场测试， 哮喘和后端口，并检查患者的程度 单独报告与索赔数据相结合，可用于创建 提供准确的护理质量评估的配置文件 健康计划，留下相对较少的措施，必须 从医疗记录中收集的。产品，在两年结束时， 会收集到一套有效、可靠、价格低廉的质量 针对3种主要慢性病的衡量标准，也可以作为典范 用于治疗其他疾病。

The measures of overall quality of care currently being developed and fielded in national quality initiatives such as NCQA, FACCT, JACHO and other organizations, are primarily designed for the general population being served by a health plan, or, if focused on specific diseases, rely on the medical record as the primary data source. Interest in surveys to capture information not contained in other sources, or to complement or substitute for more expensive and less reliable claims and medial records is increasing. Apart from expense, medical records are not adequate for assessing certain key indicators of plans performance such as patient satisfaction with health plan, quality of interpersonal care, or general or condition specific patient-perceived outcomes of care. We have developed a questionnaire containing comprehensive quality measures for patients with 3 common chronic diseases, asthma, diabetes and low back pain. This survey, designed to compare health plans, derives the majority of these general and condition-specific measures from those developed for AHCPR sponsored PORTs for the 3 index conditions. In a national field test of this questionnaire among over 12,000 patients in 39 health plans in 6 major geographically dispersed metropolitan areas, completed in August, 1997, preliminary analysis of those 4,000 patients with one of the three index conditions, suggests that these disease-specific measures of quality were more sensitive in discriminating between health plans than were general measures. We propose to conduct thorough testing of the sensitivity general vs. disease-specific quality measures in comparisons of health plans, and, using claims data, to validate many of these patient-based measures of disease-specific process and health outcomes. This proposal provides a rigorous field test of measures and methods developed in the diabetes, asthma and back PORTs, and examines the degree to which the patient report alone on in combination with claims data, can be used to create profiles that provide an accurate assessment of quality of care of health plans, leaving a relative small number of measures that must be collected from medical records. The product, at the end of two years, will be a valid, reliable and inexpensive to collect set of quality measures for 3 major chronic conditions, that can also serve as a model for other diseases.