远程医疗关键护理中介的低绩效患者诊断组的死亡率降低:研究前后的前景,研究前后的前景
Walter A Boyle1, Christopher M Palmer1, Lisa Konzen2
1Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO.
Critical care explorations
|September 27, 2023
概括
远程医疗重症监护 (TCC) 显著降低了特定高风险ICU患者群体的死亡率. 这种有针对性的方法改善了学术医疗中心中表现较差的患者群体的结果.
科学领域:
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
- 远程医疗服务是远程医疗服务.
背景情况:
- 远程医疗重症监护 (TCC) 研究的结果各不相同.
- 实施前的绩效指标对于评估TCC影响至关重要.
研究的目的:
- 评估TCC实施对风险调整后死亡率的影响.
- 根据TCC前的绩效水平对患者的影响进行分层.
主要方法:
- 在三个成年ICU进行前性,观察性,前后研究.
- 对2429名TCC前患者和12479名TCC后患者的分析.
- 针对性TCC干预针对性较低的患者群体,由高SMR确定.
主要成果:
- 整体风险调整后的死亡率显示了非显著的下降趋势 (10.7%至9.5%).
- 确定的表现较差的组体验到SMR (1.61至1.03) 和风险调整后死亡率 (26.4%至16.9%,p < 0.001) 的显著降低.
- 在表现较好的组中或停留时间长度方面没有观察到显著变化.
结论:
- 在历史上表现较差的ICU患者组中,TCC的实施成功地降低了死亡率.
- 颗粒状的性能数据 (例如,使用APACHE类别) 可以确定针对TCC干预的患者子组.
- 这些发现支持TCC前的性能与TCC驱动的改进之间的联系.
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