医院同行评审和国家实践者数据库:临床特权行动报告
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
概括
医院向国家实践者数据库 (NPDB) 报告医生行为的情况很低,并且正在下降. 这表明潜在的业绩问题报告不足,影响同行评审的完整性.
科学领域:
- 医疗保健的质量和安全
- 医疗专业主义 医学专业主义
- 医疗保健服务研究 医疗服务研究
背景情况:
- 国家实践者数据库 (NPDB) 是医生同行评审的关键资源.
- 人们担心,医院可能没有向NPDB报告有绩效问题的医生.
研究的目的:
- 分析医院向NPDB报告临床特权行为的变化和趋势.
- 调查医院特征与报告率之间的关联.
主要方法:
- 追溯性队列研究分析了1991-1995年的NPDB特权行动报告.
- 与美国4743家医院的年度医院调查 (1992,1995) 相关的数据.
- 结果指标包括行动报告和每10万入院报告率.
主要成果:
- 报告共有3328项行动;只有34.2%的医院报告至少有一项行动.
- 报告率差异很大 (0.40-52.27每10万次入院),总比率为2.36.
- 报告比例从11.6% (1991) 降至10.0% (1995);城市医院报告的比农村医院更多;教学医院成员报告的比较少.
结论:
- 医院向NPDB报告特权行动的数量很低,并且随着时间的推移而减少.
- 调查结果表明,NPDB数据可能不完整,可能会影响其对同行评审的有用性.
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