Physician Quality Reporting and Patient Outcomes in Medicare

描述（由申请人提供）：在过去的三十年中，美国医疗保健系统最重要的变化之一是在健康计划、医院和医生层面增加了医疗保健质量数据的传播。在衡量医生一级的质量方面存在着特殊的挑战。美国最大和最全面的医生质量报告工作是医疗保险的医生质量报告倡议或PQRI，始于2007年中期。这项拟议的研究将使用中断时间序列分析来检查PQRI质量指标与四种不同结果指标之间的关系：可避免的急诊室（艾德）就诊、门诊护理敏感（ACS）住院、再入院和医疗支出。分析将基于2000年至2010年的大型医疗保险索赔数据库（包括PQRI报告），以解决以下问题： 1.在横断面数据中，PQRI指标和结局指标之间是否存在关系？ 2. PQRI报告的开始是否与健康结局指标的有利变化相关？ 3. PQRI报告频率是否与健康结局指标的有利变化相关？ 4.这些结果是否因患者的种族、民族或性别而异？它们是否因慢性病的类型而异？ 此外，本研究将访谈选定的医师和CMS管理人员，探讨PQRI流程的实施和操作，以提出改进PQRI流程的方法。 PQRI是美国最大的个人提供者层面医疗保健质量数据收集工作。这项拟议中的研究是第一项旨在测试这一巨大努力是否对健康结果和支出产生影响的研究。 公共卫生相关性：美国卫生保健系统最重要的发展之一是收集有关护理质量的数据。医疗保险的医生质量报告倡议（PQRI）是全国最大的数据收集工作的医疗保健质量从个人提供者。为了了解这种质量报告是否有影响，本研究将分析医生报告，质量结果和支出之间的关系，特别注意结果是否因患者的种族，民族或性别或慢性病诊断类型而异。

DESCRIPTION (provided by applicant): One of the most important changes in the U.S. healthcare system in the past thirty years is the increased dissemination of data on health care quality at the health plan, hospital and physician level. There have been special challenges in measuring quality at the physician level. The largest and most comprehensive physician quality reporting effort in the U.S. is Medicare's Physician Quality Reporting Initiative or PQRI, begun in mid- 2007. This proposed research will use interrupted time series analyses to examine the relationship between the PQRI quality measures and four different outcome measures: avoidable emergency department (ED) visits, ambulatory care sensitive (ACS) hospitalizations, readmissions, and health expenditures. The analysis will be based on large Medicare claims data bases (including PQRI reports) covering the years 2000 to 2010, to address the following questions: 1. Is there a relationship between the PQRI measures and the outcome measures in cross-sectional data? 2. Was the onset of PQRI reporting associated with a favorable change in measures of health outcomes? 3. Was the frequency of PQRI reporting associated with a favorable change in measures of health outcomes? 4. Do these results vary according to the race, ethnicity, or sex of the patient? Do they vary by type of chronic illness? In addition, this project will interview selected physicians and CMS managers to explore the implementation and operation of the PQRI process, in order to suggest ways to improve the PQRI process? PQRI constitutes the nation's largest data collection effort on health care quality at the individual provider level. This proposed research is the first study designed to test whether this large effort has had an effect on health outcomes and expenditures. PUBLIC HEALTH RELEVANCE: One of the most important developments in the U.S. health care system has been the collection of data on quality of care. Medicare's Physician Quality Reporting Initiative (PQRI) is the nation's largest data collection effort on health care quality from individual providers. To understand if this quality reporting makes a difference, this study will analyze relationships among physician reporting, quality outcomes, and expenditures, with special attention to whether results vary according to the race, ethnicity, or sex of the patient, or by type of chronic disease diagnosis.