急性心肌梗塞的医院质量:过程措施之间的相关性和与短期死亡率的关系
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
概括
公开报告的急性心肌梗塞 (AMI) 过程测量结果显示中等相关性,但解释了医院死亡率的差异很小. 综合性质量评估需要评估多个过程和结果,包括死亡率.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
背景情况:
- 医疗保健质量指标对于患者护理评估至关重要.
- 医疗保险和医疗补助服务中心 (CMS) 和医疗保健机构认证联合委员会 (JCAHO) 报告了急性心肌梗塞 (AMI) 过程措施.
- 对于这些AMI过程措施与它们预测医院结果的能力之间的相关性,人们的理解有限.
研究的目的:
- 调查急性心肌梗塞 (AMI) 中核心过程措施之间的相关性.
- 为了确定这些AMI过程措施在多大程度上解释了医院特定,风险标准化,30天死亡率的变化.
主要方法:
- 分析了国家心肌梗塞登记处 (NRMI) 962家医院的2002-2003年数据.
- 对CMS/JCAHO AMI核心流程措施的医院绩效评估.
- 过程测量的相互关联以及医院级,风险标准化,来自Medicare索赔数据的30天死亡率.
主要成果:
- 在药物坚持措施 (β-阻断剂,阿司匹林,ACE抑制剂) 之间观察到中度至强度的相关性.
- 在药物措施和戒烟咨询或再注射时间之间发现了较弱但具有统计意义的相关性.
- 分析的过程指标总体上解释了AMI患者在医院水平,风险标准化,30天死亡率的变化仅为6.0%.
结论:
- 目前公开报道的AMI过程措施只占短期医院死亡率变化的一小部分.
- 对医院绩效的全面评估需要包括多个过程措施和结果指标,例如风险标准化死亡率.
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