高容量设施并不总是低风险:将风险标准化死亡率与设施容量进行比较,作为手术神经瘤学的质量衡量标准
Eric J Chalif1,2, Jacob S Young1, Genaro R Villa2
11Department of Neurological Surgery, University of California, San Francisco, California.
Journal of neurosurgery
|July 6, 2023
概括
风险标准化死亡率 (RSMR) 在改善质母细胞瘤手术质量和减少死亡率方面比医院体积更有效. 这一指标还突出了少数民族和低收入患者的护理差异.
科学领域:
- 神经外科瘤学 神经外科瘤学
- 医疗服务研究 医疗服务研究
- 质量改进科学 质量改进科学
背景情况:
- 设施病例数量是手术质量的传统代理.
- 风险标准化死亡率 (RSMRs) 已在其他外科领域表现出作为优越指标的前景.
- 在初级中枢神经系统 (CNS) 癌症手术中RSMRs的实用性需要研究.
研究的目的:
- 评估RSMR作为初级中枢神经系统癌症的外科质量指标.
- 为了比较基于RSMR的医院集中化模型与基于体积的医院集中化模型的有效性.
- 评估高死亡率设施治疗的社会经济预测因素.
主要方法:
- 使用国家癌症数据库 (2009-2018) 进行回顾性队列研究.
- 包括成年患有质母细胞瘤,垂体腺瘤或经过手术治疗的脑膜瘤的患者.
- 针对RSMR和体积计算的培训套件 (2009-2013),应用于验证套件 (2014-2018).
主要成果:
- 在不同瘤类型的RSMR和体积分类之间观察到实质性的差异.
- 与以体积为基础的模型相比,基于RSMR的质母细胞瘤集中需要较少的患者搬迁以预防死亡.
- RSMR更好地模拟了质母细胞瘤的整体存活率;在少数民族和低收入患者中发现的差异,这些患者在高死亡率医院接受治疗.
结论:
- 在质母细胞瘤手术中,RSMR比基于体积的方法更有效和高效地预防早期术后死亡.
- 这些发现对质量评估,医疗保健支付和减少神经外科瘤学方面的差异有影响.
- RSMR为标准化护理和评估医院绩效提供了一个有价值的工具.
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