Health Care Quality Delivered To Senior Officials: Development Of Quality Index And Preliminary Results

Background:The state attach great importance to health care for senior officials and invest a great deal of energy and financial resource to develop health care system. What about the health care quality for senior officials and how to assess the quality, is the most important things that we want to know. The quality of care among senior officials has not been extensively investigated. This study want to create a set of indicators and assess the quality of health care for senior officials. This research is the project subject to special research projects sponsored by Central Health Committee, that is, The Study on the Integrative System of Health Assessment, Early Screening and Comprehensive Intervention.Objective:(1) To develop a set of evidence-based indicators to assess the quality of health care delivered to senior cadres.(2) To measure the quality of medical care provided to hospitalized elder cadres by evaluating the process of care using the developed indicators.Methods:A modified version of the RAND/UCLA appropriateness method was used to develop indicators.1、To identify important medical conditions that affect elder cadres and for which effective menthods of prevention or management exist.A list of 21 conditions common among elder cadres was proposed on the basis of their(1)prevalence,(2)impact on health and quality of life,(3)effectiveness of interventions in improving mortality and quality of life,(4)feasibility of obtaining the data. A panel of 15 experts in geriatric care discussed and the ranked the 21 conditions on the basis of the same three criteria.We then selected 12 conditions.2、For each coditions,a contents expert created potential quality indicators (QIs) based on systematic reviews and guideline.A multidisciplinary panels of clinical experts participated in two rounds of anonymous ratings and a face-to-face group discussion to evaluate weather the QIs were valid measures of quality of health care using a process that is an explicit combination of scientific evidence and professional consensus.3、And 132 hospitalized elder cadres aged 60 or older admitted to a general hospital from Jan 1,2008 to June 30 ,2009 were studied. Using the set of indicators, the health care quality delivered to the senior officials were assessed.Results:(1) A list of 21 conditions common among elder cadre were proposed to a panel of 15 experts in geriatric care.The 12 conditions were selected as targets for quality assessment,including(in rank order):hypertension, diabetes mellitus, acute coronary syndrome,stroke, chronic obstructive pulmonary disease, benign prostatic hyperplasia, community-acquired pneumonia,heart failure,preventive service,depression,vision impairment,falls and mobility disorders.(2) 171 quality indicators on health care for cadres were assessed by the panel. 129 quality indicators (QIs),covering 12 conditons,were selected.These quality indicators coverd all five domains of care:screening and prevention(8.5% of QIs),diagnosis(30.2% of QIs),treatment(34.1% of QIs),follow up (16.3% of QIs)and health education(10.9% of QIs).(3) Participants received 80.9 percent of recommended care.Ninty percent of Qls focused on treatment were passed. This rate was higher than the adherence to QIs for care processes aimed at follow-up (80.1%), diagnosis (70.4%),health education (77.4%) or prevcntion (89.7%) . The percentage of indicated care received by participants was highest for preventive and screening(100%), lowest for falls and mobility(10%).Discussion:The study focused on developing indicators and measuring of health care quality for elder cadre.The results indicated the cadres received good medical service.But there were some deficiencies for conditions such as falls,depression.Our study has some strengths, including the methods used to construct the QIs, which involved systematic reviews,group judgment of a multidisciplinary expert panel. We also supplemented medical record information with data from patient telephone-interviews to better capture care that might nor have been recorded and ro account for patient preferences. Third, we assessed care across a very broad range of conditions that included indicators assessing prevention, treatment, diagnosis, and follow-up. Our study both calls attention to these deficiencies and provides a comprehensive method to assess the effectiveness of interventions to improve medical care.