Who is watching the watchmen: Is quality reporting ever harmful?:

SAGE Open Medicine

R ScottBraithwaite¹ 

关键词: Quality reporting;    decision analysis;    quality;    pay for performance;    physician reporting;   

DOI  :  10.1177/2050312114523425

学科分类：医学（综合）

来源: Sage Journals

【 摘 要 】

Background:Quality reporting is increasingly used as a tool to encourage health systems, hospitals, and their practitioners to deliver the greatest health benefit. However, quality reporting systems may have unintended negative consequences, such as inadvertently encouraging “cherry-picking” by inadequately adjusting for patients who are challenging to take care of, or underpowering to reliably detect meaningful differences in care. There have been no reports seeking to identify a minimum level of accuracy that ought to be viewed as a prerequisite for quality reporting.Method:Using a decision analytic model, we seek to delineate minimal standards for quality measures to meet, using the simplest assumptions to illustrate what those standards may be.Results:We find that even under assumptions regarding optimal performance of the quality reporting system (sensitivity and specificity of 1), we can identify a minimal level of accuracy required for the quality reporting system to “do no harm”: the increase in h...

【 授权许可】

CC BY