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Combining state administrative databases and provider records to assess the quality of care for children enrolled in Medicaid

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AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第2期14卷 98-104页

作者： Cotter, JJ Smith, WR Rossiter, LF Pugh, CB Bramble, JD Virginia Commonwealth Univ Med Coll Virginia Div Qual Hlth Care Dept Internal Med Richmond VA 23298 USA Creighton Univ Omaha NE 68178 USA

Our objective was to assess the capability of state administrative health care databases to evaluate the quality of immunization rates for a Medicaid managed care population. Data on 5599 2 year olds were obtained from a Medicaid claims database, a health department database, and the records of the children's assigned providers. The study was conducted on 1 managed care program in 1 state. Test performance ratio analyses were used to assess the relative accuracy and contribution of each source of administrative data. We found that of the 67,188 doses needed, 45,511 (68%) were documented as administered per at least 1 of the data sources. Medicaid claims data alone accounted for 18% of immunized children, while health department data used by itself accounted for 12%. Together, these 2 sources identified 34% of immunized children. Large administrative databases, such as Medicaid claims and data from a health department, while valuable sources of information on quality, may underestimate outcomes such as immunization rates. Assessments of the quality of health care should rely on a combination of administrative data and providers' records as sources of information.

关键词：儿童保健服务/标准免疫法/利用保险索赔审核管理医疗规划/标准 Medicaid/利用病案连锁公共卫生管理质量保证卫生保健/方法美国女(雌)性人类婴儿男(雄)性

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Editorial: Quality in managed care?

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AMERICAN JOURNAL OF MEDICAL QUALITY 2003年第1期18卷 1-2页

作者： MacKoul, DA

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Managed care: US research evidence and its lessons for the NHS

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Journal of Health Services Research and Policy 1998年第3期3卷 173-184页

作者： Steiner, A. Robinson, R. Institute for Health Policy Studies University of Southampton Southampton SO17 1BJ 129 University Road United Kingdom

Objectives: To review the high quality US evidence on performance of managed health care organisations and the available US evidence on specific managed care techniques;namely, financial incentives, utilisation management and review, physician profiling and disease management. Methods: Literature searches were conducted using numerous databases including Medline, Embase, the Social Sciences Citation Index and the National Health Service (NHS) Centre for Reviews and Dissemination library. For inclusion of evaluations of overall performance, studies had to use a comparison group (typically fee-for-service patients), make appropriate statistical adjustments for differences between groups, and be published in a peer-reviewed journal from 1980 forward. For assessments of techniques, less-demanding inclusion criteria reflected the paucity of generalisable literature;however, more current results were required (1990 forward). Results: We identified 70 articles for systematic review, covering 18 dimensions of performance (e.g. utilisation, quality of care, consumer satisfaction, equity). The strength of the evidence varied by dimension. It was strongest for utilisation and quality. In general, managed care seems to reduce hospitalisation and use of high-cost discretionary services, to increase preventive screening, and to be neutral in terms of patient outcomes. As for specific techniques, we identified 19 articles for review, but limitations of these studies prevented our drawing any definite conclusions about techniques' effectiveness. This is an important, if somewhat negative, conclusion. Conclusions: Applying US evidence is complicated by an irrelevant comparator and a higher baseline of utilisation. Managed care brought Americans the familiar NHS practices of population-based health care and resource management through gatekeeping;hence, changes due to UK adoption of managed care techniques may be modest. US evidence should be used to generate hypotheses, not to predi

关键词：疾病管理评价研究按诊疗收费计划/组织和管理按诊疗收费计划/标准按诊疗收费计划/利用大不列颠卫生保健公平提供卫生服务研究管理医疗规划/组织和管理管理医疗规划/标准管理医疗规划/利用模型组织管理医师奖励计划医师诊疗模式公费医疗美国利用情况审核人类

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The national outcomes management project: A benchmarking collaborative

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第4期27卷 431-436页

作者： Dewan, NA Daniels, A Zieman, G Kramer, T Alliance Behav Care Cincinnati OH USA Ctr Outcomes Res & Effectiveness Little Rock AR USA

Traditional evaluation of health care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a measurement of either process or outcomes, and a real-time or retrospective feedback of the results of data measurement. Benchmarking, a well-known efficient business technology, can lead to practice innovations necessary to survive in an environment that has a need for decreasing cost and increasing quality. The purpose of this article is to present a novel use of benchmarking in managed ambulatory behavioral health care and its application in a model collaborative outcome management project at more than 16 sites and nine states in the United States.

关键词：门诊医疗设施/组织和管理门诊医疗设施/标准规范社区精神卫生服务/组织和管理社区精神卫生服务/标准管理医疗规划/组织和管理管理医疗规划/标准病案模型组织管理结果与过程评价(卫生保健)/方法地区医疗规划/组织和管理美国人类

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Reinterpreting the Fort Bragg Evaluation findings: The message does not change

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第1期23卷 137-145页

作者： Bickman, L VANDERBILT UNIV INST PUBL POLICY STUDIES1207 18TH AVE SNASHVILLETN 37212 USA

Examines the comments made about the evaluation of the Fort Bragg Demonstration. Identification of comments in study; Clarification of these.

关键词：管理医疗规划/经济学管理医疗规划/组织和管理管理医疗规划/标准精神卫生服务/经济学精神卫生服务/组织和管理精神卫生服务/标准军事医学/经济学模型组织管理北卡罗来纳/流行病学结果评价(卫生保健) 试点项目方案评价/方法人类

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Developing a strategic plan for quality in pharmacy practice

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2000年第5期57卷 470-474页

作者： Shane, R Gouveia, WA Cedars Sinai Med Ctr Serv Pharm Los Angeles CA 90048 USA Tufts Univ New England Med Ctr Serv Pharm Boston MA 02111 USA

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Improving managed care through coding, monitoring, and trending quality-of-care concerns.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第1期20卷 20-23,26-28页

作者： Miller, J.A. Lowe, P.V. Physicians Health Plan of Mid-Michigan Lansing United States

With the rise of managed care, purchasers and payers are increasingly demanding value in healthcare. Traditionally, patient satisfaction surveys and focus groups have been used to elicit information regarding customers' perspectives. This article explores the use of an inexpensive alternative methodology--that of monitoring quality-of-care concerns and complaints. A nomenclature and a process for tracking, trending, and reporting quality-of-care issues are detailed;they encompass both the patient's and the provider's perception of a specific care experience. This methodology promotes the use of quantifiable data to support strategic planning and compliance with National Committee for Quality Assurance accreditation standards.

关键词：表格和记录管理管理医疗规划/标准病人满意度同行评议卫生保健过程评价(卫生保健) 危险处理/分类危险处理/方法软件设计全面质量管理/方法美国

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Implications of a children's mental health managed care demonstration evaluation

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第1期23卷 107-117页

作者： Bickman, L VANDERBILT UNIV VANDERBILT INST PUBL POLICY STUDIES1207 18TH AVE SNASHVILLETN 37212 USA

This article summarizes the major findings of the Fort Bragg Evaluation and considers alternative explanations for the results. The evaluation found that the continuum of care provided a high-quality system of care but was more expensive and produced no better clinical outcomes than traditional services. The possibility of implementation failure at both the systems and services levels is considered and rejected as an explanation for the results. Support for the validity of the measurement, design, and the analysis is also presented. The implications for research and policy are described.

关键词：青少年保健服务/经济学青少年保健服务/标准儿童保健服务/经济学儿童保健服务/标准病人医护连续性/经济学病人医护连续性/标准雇主承担保健费用政府机构保健福利计划雇员/经济学保健福利计划雇员/标准管理医疗规划/经济学管理医疗规划/标准精神卫生服务/经济学精神卫生服务/标准军事医学模型组织管理北卡罗来纳/流行病学试点项目方案评价可重复性结果青少年儿童人类

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CONQUEST 2.0: an emerging clinical performance measurement tool.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2000年第3期22卷 29-36页

作者： Keyes, M.A. [?]Margaret A. Keyes is an expert appointee at the Agency for Health Care Policy and Research (AHCPR). She has worked in AHCPR's Center for Quality Measurement and Improvement since April 1995. As a project officer there Ms. Keyes is responsible for managing contracts and grants related to quality and performance measurement most notably CONQUEST. Previously Ms. Keyes was a researcher and manager for 13 years at a Washington DC health services research and consulting firm. Ms. Keyes has a BBA from Marymount University and an MA from Central Michigan University.

Variations in quality of healthcare have existed for many years, yet interest in measuring, understanding, and eliminating these variations has waxed and waned. The advent of managed care and its perceived focus on reducing costs has stimulated interest in variations in quality of care. In response to the need to better understand and measure quality, the Agency for Health Care Policy and Research (AHCPR) funded the development of a tool capable of categorizing clinical performance measures, a subset of quality measures, for comparing and evaluating them relative to a user's specific needs for measuring and improving quality. This research lead to the development of the COmputerized Needs-oriented QUality measurement Evaluation SysTem (CONQUEST)--a free software quality improvement tool that includes about 1,200 clinical performance measures. CONQUEST enables users to quickly identify measures of interest, compare them on the basis of factors of importance, and select measures that will help them measure and improve care.

关键词：社区卫生计划数据库管理系统糖尿病 2型/治疗管理医疗规划/标准试点项目方案评价质量指标卫生保健/分类可重复性结果软件全面质量管理/标准美国美国卫生保健研究和质量评估署成年人人类

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How consumers evaluate health care quality: Part i

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Health Marketing Quarterly 1999年第4期16卷 1-6页

作者： Moore, Stephen T. Bopp, Kenneth D. School of Social Work University of Missouri Columbia MO 65211 324 Clark Hall United States Health Service Management Group University of Missouri Columbia MO 65211 324 Clark Hall United States

Information is a critical factor in marketing health care services. Consumers evaluate information according to its source. This report is the first of a three-part series examining the way in which Americans evaluate the quality of consumer information as they make decisions on health care products and services. This report provides an overview of the study. The next two installations will focus, respectively, on health plans, hospital and doctors. © 1999 by The Haworth Press, Inc. All rights reserved.

关键词：用户满意/统计学和数值数据评价研究医院/标准管理医疗规划/标准卫生服务使用研究医师/标准质量指标卫生保健美国成年人人类

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