公共报告卡在改善心脏护理质量的有效性:EFFECT研究:一项随机试验
Jack V Tu1, Linda R Donovan, Douglas S Lee
1Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave, Toronto, ON M4N 3M5, Canada. tu@ices.on.ca
JAMA
|November 20, 2009
概括
公开发布的医院报告卡并没有显著改善心脏病发作或心力衰竭的护理过程. 然而,报告卡的早期反与心脏病发作死亡率的小但显著降低有关.
科学领域:
- 医疗服务研究 医疗服务研究
- 提高质量 提高质量
- 公共卫生政策 公共卫生政策
背景情况:
- 公共可用的医院绩效报告卡越来越常见.
- 这些报告卡在改善护理质量的有效性是不确定的.
研究的目的:
- 评估心脏质量指标的公开发布是否促使医院改善护理流程和患者的治疗结果.
- 评估公共报告卡对质量改进活动的影响.
主要方法:
- 一个基于人口的集群随机试验 (用于有效心脏治疗的增强反 (EFFECT)) 涉及加拿大安大略省86家医院公司.
- 医院被随机分配到对心脏质量指标 (急性心肌梗塞[AMI]和充血性心力衰竭[CHF]) 的公共报告卡的早期或延迟反.
- 主要结局包括复合的AMI和CHF治疗过程指标;次要结局包括死亡率.
主要成果:
- 报告卡的公开发布并没有显著改善AMI (1.5%变化) 或CHF (0.6%变化) 的综合护理过程指标.
- 与延迟反组相比,在早期反组中观察到30天AMI死亡率 (2.5%) 的显著降低.
- 两组之间没有发现CHF医院死亡率的显著差异.
结论:
- 公开发布医院特定的质量指标并没有显著提高AMI或CHF的综合治疗过程指标.
- 报告卡的早期反显示出在减少AMI死亡率方面具有潜在的益处,这需要进一步调查.
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