Benefits and harms of CT screening for lung cancer: A systematic review (Journal of the American Medical Association (2012) 307, 22, (2418-2429))

摘要

Our model has consequences for quality improvement efforts, however. Sometimes, we must devote resources that other medical organizations might use to improve quality scores to support enabling services. As an example, we think it is a better use of our resources to coordinate care for our most complex patients than to achieve mammography screening rates that are far above the national benchmark (particularly given recent concerns that mammography guidelines may not be evidence based2). The net result is that our "quality scores," while above average for safety net organizations, often do not quite reach national benchmarks. This concern is not unique to our organization. It is also not unique to the safety net. Each patient population has its own needs and challenges! For some populations, traditional quality measures such as cancer screening rates and process measures for diabetes care-which were chosen largely because they are easy to measure and consistent with the traditional medical model of disease-might be appropriate. But for other populations-such as those with chronic illnesses, food insecurity, or drug and alcohol addictions- these measures are "non-patient centric" and may result in the redirection of precious resources away from the services patients most need and toward services that are tracked in quality reports.