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病例采样与普遍审查用于评估美国手术质量改善计划中的医院术后死亡率
Vivi W Chen1,2, Alexis P Chidi3, Tracey Rosen1,4
1Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
使用病例采样进行的外科质量改进计划可能会错过许多比预期死亡率高的医院. 这表明采样可能不准确地反映整体的外科手术性能或指导质量改进的努力.
科学领域:
- 医疗保健的质量 医疗保健的质量
- 外科手术的结果
- 相对的有效性比较
背景情况:
- 国家手术质量改进 (QI) 计划经常使用代表性病例抽样来评估绩效.
- 这种抽样策略对于识别有安全性或质量问题的医院的稳定性尚不清楚.
研究的目的:
- 评估国家手术QI计划中的采样策略是否提供有关医院质量和安全的代表性数据.
- 为了比较样本和通用病例审查之间的30天死亡率.
主要方法:
- 一项全国性,医院级的比较有效性研究分析了来自113家美国退伍军人事务部医院的数据.
- 包括2016年1月至2020年9月期间接受非心脏手术的成年患者.
- 观察到预期 (O-E) 死亡率的比率是使用样本和通用病例数据来计算的,以确定异常医院.
主要成果:
- 与普遍审查相比,外科病例抽样发现了较少的异常医院 (11.7%与13.2%的季度).
- 通过普遍审查确定的异常医院病房中,不到一半也通过抽样 (47.4%) 确定.
- 通过采样确定的异常医院的30天死亡率高于非异常医院 (1.0%与非采样病例的0.5%相比).
结论:
- 采样策略可能无法充分识别比预期更高的术后死亡率的医院.
- 调查结果表明,采样可能不完全代表整体手术程序的性能.
- 采样数据可能不足以为有效的质量改进计划提供信息.
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