病院のピアレビューと国家実務者データバンク:臨床特権行動報告書
L M Baldwin1, L G Hart, R E Oshel
1Department of Family Medicine and Washington Wyoming Alaska Montana Idaho (WWAMI) Rural Health Research Center, University of Washington, Seattle 98195-4696, USA. lmb@u.washington.edu
JAMA
|August 4, 1999
まとめ
医療従事者の行動に関する病院の報告は,全国医療従事者データバンク (NPDB) に低水準で,減少傾向にあります. これは,パフォーマンスの問題に関する報告が不足している可能性を示唆し,ピアレビューの完全性に影響を与えます.
科学分野:
- 医療の質と安全について
- 医療のプロフェッショナリズム
- 医療サービス 研究 医療サービス
背景:
- 国家実務者データバンク (NPDB) は,医師のピアレビューのための重要なリソースです.
- 病院がNPDBに,パフォーマンスの問題のある医師の潜在的報告不足について懸念があります.
研究 の 目的:
- NPDBへの臨床特権に関する病院報告の変動と傾向を分析する.
- 病院の特徴と報告率の関連性を調査する.
主な方法:
- NPDBの特権行動報告書を分析した1991年から1995年の遡及的なコホート研究.
- 病院の年次調査 (1992年,1995年) にリンクされたデータは,米国の4743の病院について.
- 結果指標には,行動の報告と10万入院あたりの報告率が含まれていました.
主要な成果:
- 合計3328件のアクションが報告されましたが,少なくとも1件のアクションを報告したのは病院の34.2%に過ぎません.
- 報告率は幅広く変化した (入院10万人に0.40~52.27),全体の割合は2.36であった.
- 報告する割合は11.6% (1991年) から10.0% (1995年) に減少した. 都市病院は農村部よりも多く報告し,教養病院のメンバーはより少なく報告した.
結論:
- NPDBへの特権措置の病院報告は低く,時間の経過とともに減少しています.
- 調査結果は,NPDBのデータは不完全であり,ピアレビューの有用性に影響を与える可能性があることを示唆しています.
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