了解因行政卫生数据编码不准确而导致的败血症监测和质量保证方面的偏差
Daniel Schwarzkopf1, Norman Rose2, Carolin Fleischmann-Struzek2
1Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. Daniel.Schwarzkopf@med.uni-jena.de.
Infection
|September 8, 2023
概括
住院行政卫生数据 (IAHD) 严重低估了德国的败血症发病率和负担,这是由于编码不足. IAHD不适合评估败血症护理质量.
科学领域:
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
背景情况:
- 准确的败血症流行病学数据对于政策和研究至关重要.
- 住院行政健康数据 (IAHD) 用于监测和质量保证.
- 对于败血症监测IAHD的有效性需要调查.
研究的目的:
- 评估IAHD对于败血症监测和质量保证的准确性.
- 根据图表审查,验证IAHD中败血症和死亡风险因素的编码.
- 为了比较从IAHD计算的医院级败血症死亡率与图表评论.
主要方法:
- 从2015年至2017年,德国十家医院对10334例住院病例 (年龄≥15岁) 进行了回顾性验证研究.
- 与图表审查诊断相比,在IAHD中评估了败血症编码和死亡风险因素的准确性.
- 从IAHD和图表审查中比较医院特异性风险调整的败血症死亡率.
主要成果:
- IAHD显示出高阳性预测值的败血症编码 (76.9-85.7%),但低灵敏度 (26.8-38%),导致低估发病率.
- 低编码与患者病历中没有命名败血症有关.
- 观察到在败血症诊断和编码准确性方面存在显著的医院级差异.
- 风险调整后IAHD和图表审查之间的死亡相关性很弱 (r=0.09).
结论:
- IAHD低估了德国败血症的真正负担.
- 在败血症诊断和编码准确性方面,医院的变异性很大.
- 单独的IAHD不足以评估败血症护理的质量.
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