医院的特点和护理质量
E B Keeler1, L V Rubenstein, K L Kahn
1Health Program of RAND, Santa Monica, CA.
JAMA
|October 7, 1992
概括
医院质量因类型而异,教学,大型和城市医院通常提供更好的护理. 尽管差距有所缩小,但医院类别之间死亡率仍然存在显著差异.
科学领域:
- 医疗保健质量评估 医疗保健质量评估
- 医院绩效分析 医院绩效分析
- 医疗保险患者的结果
背景情况:
- 评估医疗保健质量对于患者的治疗结果和资源分配至关重要.
- 未来的支付系统会影响医院护理质量.
- 了解不同机构医院质量的差异至关重要.
研究的目的:
- 用明确标准,隐性审查和疾病调整后的结果来比较医院护理质量.
- 分析未来支付对医疗保险患者护理质量的影响.
- 确定医院特征与护理质量之间的关系.
主要方法:
- 对来自五个州的297家医院的医疗记录进行了回顾性分析.
- 包括14008名患有五种主要疾病的老年患者 (充血性心力衰竭,心肌梗塞,肺炎,中风,关节骨折).
- 使用明确标准,隐性审查和根据患者入院时的疾病调整后的30天死亡率进行质量评估.
主要成果:
- 在明确的标准,隐性审查和疾病调整后的结果中一致的质量评级.
- 医院类型之间存在显著的质量差异;质量较差的医院死亡率较高.
- 教学,大型和城市医院通常表现出比非教学,小型和农村医院更好的护理质量.
结论:
- 多项测量证实了医院特征与护理质量之间的合理关系.
- 通过这些评估方法,可以获得有关医院质量的有效信息.
- 需要进一步开发以利用医院质量数据来改善患者护理.
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