从措施到行动:整合质量措施能否为质量改进决策提供全系统的见解?

IF 4.1 Q1 HEALTH CARE SCIENCES & SERVICES
Inas S Khayal, Jordan T Sanz
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引用次数: 0

摘要

背景:质量改进决策者只能从大量狭隘的措施中发展对医疗保健系统质量的理解,这些措施反映了现有的护理碎片化,缺乏触发改进的明确方法。一对一的度量到改进策略是难以处理的,并且会导致意想不到的后果。虽然已经使用了复合测量方法,并且在文献中指出了它们的局限性,但仍然未知的是“整合多种质量测量方法能否提供对整个医疗保健系统的护理质量的系统理解?”“方法:我们设计了一个由四部分组成的数据驱动的分析策略,以确定是否存在一致的见解,关于临终关怀的不同利用,使用多达八种公开可用的临终癌症护理质量措施,在国家癌症研究所和国家综合癌症网络指定的癌症医院/中心。”本研究共进行了92项实验,包括28项相关分析、4项主成分分析、6项跨医院层级聚类平行坐标分析和54项各医院层级聚类平行坐标分析。结果:在54个中心中,综合质量措施在不同的综合分析中没有提供一致的见解。换句话说,我们无法整合质量指标来描述在不同患者中,如何相对地使用以下因素的潜在质量结构:重症监护室(ICU)就诊、急诊科(ED)就诊、姑息治疗的使用、缺乏临终关怀、近期临终关怀、生命维持治疗的使用、化疗和预先护理计划。质量测量计算缺乏相互联系的信息,无法构建一个故事,提供有关在何处、何时或向哪些患者提供何种护理的见解。然而,我们假设并讨论了为什么行政索赔数据-用于计算质量度量-包含这样的互连信息。结论:虽然整合质量措施不能提供系统信息,但可以从相同的行政索赔数据中开发新的系统数学结构来传递相互关联的信息,以支持质量改进决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

From measures to action: can integrating quality measures provide system-wide insights for quality improvement decision making?

From measures to action: can integrating quality measures provide system-wide insights for quality improvement decision making?

From measures to action: can integrating quality measures provide system-wide insights for quality improvement decision making?

From measures to action: can integrating quality measures provide system-wide insights for quality improvement decision making?

Background: Quality improvement decision makers are left to develop an understanding of quality within their healthcare system from a deluge of narrowly focused measures that reflect existing fragmentation in care and lack a clear method for triggering improvement. A one-to-one metric-to-improvement strategy is intractable and leads to unintended consequences. Although composite measures have been used and their limitations noted in the literature, what remains unknown is 'Can integrating multiple quality measures provide a systemic understanding of care quality across a healthcare system?'

Methods: We devised a four-part data-driven analytic strategy to determine if consistent insights exist about the differential utilisation of end-of-life care using up to eight publicly available end-of-life cancer care quality measures across National Cancer Institute and National Comprehensive Cancer Network-designated cancer hospitals/centres. We performed 92 experiments that included 28 correlation analyses, 4 principal component analyses, 6 parallel coordinate analyses with agglomerative hierarchical clustering across hospitals and 54 parallel coordinate analyses with agglomerative hierarchical clustering within each hospital.

Results: Across 54 centres, integrating quality measures provided no consistent insights across different integration analyses. In other words, we could not integrate quality measures to describe how the underlying quality constructs of interest-intensive care unit (ICU) visits, emergency department (ED) visits, palliative care use, lack of hospice, recent hospice, use of life-sustaining therapy, chemotherapy and advance care planning-are used relative to each other across patients. Quality measure calculations lack interconnection information to construct a story that provides insights about where, when or what care is provided to which patients. And yet, we posit and discuss why administrative claims data-used to calculate quality measures-do contain such interconnection information.

Conclusion: While integrating quality measures does not provide systemic information, new systemic mathematical constructs designed to convey interconnection information can be developed from the same administrative claims data to support quality improvement decision making.

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来源期刊
CiteScore
6.10
自引率
4.90%
发文量
40
审稿时长
18 weeks
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