急性心筋梗塞の病院の質:プロセス測定の相関関係と短期死亡率との関連
Elizabeth H Bradley1, Jeph Herrin, Brian Elbel
1Department of Epidemiology and Public Health, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Conn 06520-8088, USA.
JAMA
|July 6, 2006
まとめ
公に報告された急性心筋梗塞 (AMI) プロセスの測定は,中程度の相関を示しているが,病院での死亡率の変動はほとんど説明できない. 総合的な品質評価には,死亡率を含む複数のプロセスと結果を評価する必要があります.
科学分野:
- 心臓病学 心臓病学
- 医療サービス 研究 医療サービス
- 品質の向上 品質の向上
背景:
- 医療品質指標は,患者ケア評価において極めて重要です.
- メディケア・メディケイド・サービスセンター (CMS) と医療機関の認定に関する共同委員会 (JCAHO) は,急性心筋梗塞 (AMI) プロセスの測定を報告しています.
- これらのAMIプロセスの測定値と,病院の結果を予測する能力の間の相関に関する理解は限られている.
研究 の 目的:
- 急性心筋梗塞 (AMI) のコアプロセスの測定値の間の相関を調査する.
- これらのAMIプロセスの測定が,病院特有のリスク標準化された30日間の死亡率の変動をどの程度説明するかを決定する.
主な方法:
- 国立心筋梗塞登録局 (NRMI) の962の病院から2002年から2003年のデータを分析した.
- CMS/JCAHO AMIのコアプロセスの指標に関する病院のパフォーマンスの評価.
- プロセス測定の相互関係と,メディケア請求データからの病院レベルのリスク標準化,30日間の死亡率との相関.
主要な成果:
- 薬の服用量 (ベータブロッカー,アスピリン,ACE阻害剤) の間で,中等から強い相関が観察されました.
- 薬剤の処置と禁煙カウンセリングや再注射時間との間には,より弱い,しかし統計的に有意な相関が認められた.
- 分析されたプロセスの測定は,AMI患者の病院レベル,リスク標準化,30日間の死亡率の変動の6.0%のみを集約的に説明しました.
結論:
- 現在公に報告されているAMIプロセスの測定は,短期間の病院死亡率の変動のわずかな部分を占めています.
- 病院のパフォーマンスの包括的な評価には,リスク標準化された死亡率などの複数のプロセス測定値と結果指標の含めが必要です.
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