手术死亡率作为医院质量的指标:样本规模小的问题
Justin B Dimick1, H Gilbert Welch, John D Birkmeyer
1VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt 05009, USA. justin.b.dimick@dartmouth.edu
JAMA
|August 19, 2004
概括
大多数医院缺乏足够的病例来可靠地评估手术质量,使用复杂手术的死亡率. 冠状动脉旁路移植手术 (CABG) 是一个例外,大多数医院满足最低病例数量.
科学领域:
- 医疗保健质量测量 医疗保健质量测量
- 手术结果研究研究.
- 医院绩效分析 医院绩效分析
背景情况:
- 手术死亡率越来越多地被用作医院质量评估的指标.
- 医院病例数量是否足以可靠地识别质量问题仍然不清楚.
研究的目的:
- 评估作为质量指标推的七种特定外科手术是否进行足够频繁以可靠地检测增加的死亡率.
- 这些程序包括冠状动脉旁路移植 (CABG) 手术,腹腔大动脉动脉瘤修复,胰腺切除,食道切除,儿科心脏手术,骨切除和关节置换.
主要方法:
- 对2000年全国住院患者样本 (NIS) 的分析,以确定七种手术的全国平均死亡率和医院病例数量.
- 进行了样本大小计算,以确定可靠地检测全国平均死亡率翻一番所需的最低案件量,从而定义了表现不佳.
主要成果:
- 检测双重死亡率的最低案件数量有很大差异,从切除术的64例到关节置换术的2668例.
- 只有冠状动脉旁路移植手术 (CABG) 显示出足够的病例,90%的医院超过了219例的最低要求.
- 对于其他手术,很少有医院达到最低病例数量:切除 (33%),儿科心脏手术 (25%),腹腔大动脉动脉瘤修复 (8%),胰腺切除 (2%),食道切除 (1%) 和关节置换 (<1%).
结论:
- 除了冠状动脉旁路移植 (CABG) 手术外,大多数医院没有足够频繁地进行选择的手术程序,以可靠地评估基于死亡率的质量.
- 这些发现表明,由于医院病例数量较低,许多高风险手术的死亡率作为唯一质量指标的使用存在局限性.
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