2015年2月11日
西北医学专家认为，财政处罚可能会在不经意间惩罚优质医院
与# 65279；芝加哥–；一个新的编辑
出版日本汽车制造商协会通过西北医学；
experts strongly questions the use of several
hospital quality measures通过the Centers for Medicare & Medicaid Services
(CMS) in its pay-for-performance programs. These eight measures， collectively
known as the 病人
安全指标90（psi-90）
composite measure， account for about a third
of CMS’ Hospital-Acquired Condition (HAC) Reduction Program和 Hospital
Value-Based Purchasing (VBP) Program scores， which financially penalize
hospitals with the poorest scores. 这个编辑 argues that flaws in the
PSI-90 measure和 its use in CMS’ programs inaccurately identify problems in
hospital care和 cause hospitals to be unfairly penalized. &ldquo；的psi-90措施原本是用来帮助医院测量的不良事件和解决他们自己的质量改进的努力，”；
作者说卡尔Y. Bilimoria医师，医学博士，硕士，
副主席为质量西北医学和 director of the Surgical Outcomes和 Quality Improvement Center at Northwestern University Feinberg School of Medicine. “These measures were not designed to be representative of a hospital’s overall quality， let alone used通过an organization like CMS as a determining factor in how much they reimburse or penalize hospitals for the quality of care they provide.”
这个PSI-90 component measures track the rate of eight different adverse events including blood clots， pressure ulcers， hip fracture和 infections. First used通过CMS in its pay-for-performance programs in 2014， these eight PSI-90 measures now account for 35 percent of CMS’ overall HAC Reduction Program score和 30 percent of their Hospital VBP program.
One of the main problems identified通过the 编辑， “Concerns About Using the Patient Safety Indicator-90 Composite in Pay-for-Performance Programs，” is that PSI-90 contains flawed measures due to surveillance bias. A recent
日本汽车制造商协会研究psi-12，追踪患者确诊率
外科手术后的血凝块，和 found that hospitals with higher rates of postoperative bloods clots were often the hospitals that were most vigilant in screening patients for them. Thus， high-quality hospitals often paradoxically appeared to be providing poor care. 这个PSI-12 measure和 other PSI-90 components， like PSI-03 which monitors rates of pressure ulcers， were found to potentially penalize hospitals that are proactively screening patients for surgical complications.
“Ensuring patients following surgery are appropriately screened for blood clots和 pressure ulcers plays an important role in providing safe， high-quality care for patients，” said 加里答：没有皮，MD，
senior vice president和 chief medical officer at Northwestern Memorial和 professor of medicine at 费因伯格学派。&ldquo；绩效工资政策应该奖励医院，做一个识别这些条件之前，他们对病人造成伤害的工作出色，但目前这些措施做相反的。”； 作者还认为，CMS &rsquo；在psi-90措施绩效工资的支付会导致其他问题，包括：
- Individual complications being redundantly counted通过both the Hospital VBP program和 HAC Reduction Program，
- Failure to accurately distinguish harmful complications from those that resulted in little to no harm，和
- 医院住院病人群体差异的不充分性。
“Beyond the flaws that many of the measures have independently， one the major concerns we raise is that CMS’ pay-for-performance programs weigh the importance of each PSI-90 measure based how often their complications occur， not on their clinical implications，” said Bilimoria， who is also a member of the Robert H. Lurie Comprehensive Cancer Center. “This leaves out consideration of differences in a complication’s increased length of stay， cost， morbidity和 risk of mortality， all of which vary widely between the PSI-90 composite measure’s components.”
Even with the potential flaws discussed通过the authors， they conclude that the measures can still be effective in pay-for-performance programs if they are properly constructed.
“这个complications that these measures monitor are important和 should be areas of focus for quality improvement in hospitals， but issues like surveillance bias， redundancy和 lack clinical relevancy need to be corrected to encourage real healthcare improvement，” added Bilimoria.
这个日本汽车制造商协会 编辑 was published online on February 5， 2015和 is available on the 日本汽车制造商协会网站。媒介接触：
布雷特昆斯
高级媒体关系副
312-926-2955
bcoons@nm.org
