病院の特徴と医療の質
E B Keeler1, L V Rubenstein, K L Kahn
1Health Program of RAND, Santa Monica, CA.
JAMA
|October 7, 1992
まとめ
病院の質は種類によって異なるが,一般的には,教育,大型,都市病院がより良いケアを提供している. ギャップが少し縮小したにもかかわらず,病院のカテゴリー間で死亡率の有意な違いが続いている.
科学分野:
- 医療の質評価 医療の質評価 医療の質評価 医療の質評価 医療の質評価 医療の質評価 医療の質評価
- 病院のパフォーマンスの分析
- メディケア患者のアウトカムについて
背景:
- 医療の質の評価は,患者の成果とリソースの配分に極めて重要です.
- 将来の支払いシステムは,病院医療の質に影響を及ぼします.
- 病院の質の違いを様々な機関で理解することは不可欠です.
研究 の 目的:
- 病院での医療の質を明示的な基準,暗黙のレビュー,および病気に調整されたアウトカムを使用して比較する.
- メディケア患者の医療の質に対する将来の支払いの影響を分析する.
- 病院の特徴と医療の質との関係を特定する.
主な方法:
- 5つの州の297の病院の医療記録を遡及的に分析した.
- 5つの主要疾患 (心不全,心筋梗塞,肺炎,脳卒中,股関節骨折) を患った14008人の高齢者を対象とした調査.
- 明確な基準,暗黙のレビュー,入院時の患者の病気に調整された30日間の死亡率を使用して品質の評価.
主要な成果:
- 明確な基準,暗黙のレビュー,および病気に調整された結果に関する一貫した品質評価.
- 病院の種類間の質の違いが顕著で,質の低い病院では死亡率が高かった.
- 教師,大型,都市病院は,一般的には,非教師,小型,農村病院よりも優れたケア品質を示しました.
結論:
- 複数の測定法によって,病院の特徴と医療の質との間に妥当な関係があることが確認されています.
- これらの評価方法によって,病院の質に関する有効な情報を得ることができます.
- 患者のケアを改善するために病院の品質データを活用するためにさらなる開発が必要である.
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