在看医生观察者. 同行评审组织方法有多好地发现医院护理质量问题?
H R Rubin1, W H Rogers, K L Kahn
1Department of Medicine, Johns Hopkins University, Baltimore, Md.
JAMA
|May 6, 1992
概括
一个州的同行评审组织 (PRO) 对医院护理质量的审查显示,与独立研究判断的一致性不佳. 在PRO的选过程中,错过了许多不符合标准的案例,表明需要改进质量评估方法.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
- 医学审计 医学审计
背景情况:
- 同行评审组织 (PRO) 的任务是评估医疗保险受益人的医院护理质量.
- 评估PRO质量判断的准确性和有效性对于医疗保健系统监督至关重要.
- 之前的研究已经强调了医疗保健质量评估方法的变化.
研究的目的:
- 将一个州的PRO对医院护理判断的质量与一个独立的,严格的研究判断进行比较.
- 评估PRO审查过程中的不同阶段的表现,包括初始查和医生审查.
- 确定质量评估PRO方法的改进领域.
主要方法:
- 采用了回顾性研究设计,将PRO评论与独立的"研究判断"进行比较.
- 在一个州 (1985-1987) 的医疗保险住院记录被随机审计.
- "研究判断"涉及内科医生和外科医生的盲目,结构化,隐性审查,评估护理标准,标准以上或标准以下.
主要成果:
- 该PRO确定了6.3%的病例是质量问题,而独立研究认为18%的病例低于标准护理.
- 在PRO的初始查中,未能确定三分之二的记录被研究认为低于标准.
- PRO与研究判断之间的一致性很小,特别是在识别低质量的护理方面;PRO只发现了11%的不合格病例.
结论:
- 该PRO审查过程需要显著改进,特别是在初始查准确度上,以确定更不符合标准的护理.
- 通过结构化方法和培训,提高医生审查的准确性和可重复性至关重要.
- 目前的PRO查过程表现出有限的有效性,在识别不符合标准的护理方面,其表现仅略高于随机机会.
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