老年人创伤质量的变化,当使用长期结果与住院死亡率进行评估时
Cheryl K Zogg1,2,3, Zara Cooper2,4, Peter Peduzzi5
1Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
JAMA surgery
|October 4, 2023
概括
评估长期创伤护理的老年人使用复合分数的退院后的指标,包括再入院和健康的日子在家中,提供了一个更准确的质量评估比单独在医院死亡率.
科学领域:
- 老年人创伤护理 创伤护理
- 医疗保健质量评估 医疗保健质量评估
- 医疗保健服务研究 医疗服务研究
背景情况:
- 创伤系统往往缺乏关于患者长期结果的数据,在质量评估中造成知识差距.
- 现有的质量指标正在扩大,包括放弃后的措施,但它们的最佳使用仍然不清楚.
- 住院死亡率是传统的指标,但可能无法完全反映老年创伤患者的护理质量.
研究的目的:
- 评估由推的放电后质量指标得出的复合得分的实用性.
- 在评估医院级因素时,将这个综合分数的表现与医院内死亡率进行比较.
- 在老年人创伤护理中,探索复合分数表现和医院特征之间的关联.
主要方法:
- 一个国家医院级的质量评估,使用医疗保险65岁以上的成年人因创伤,关节骨折或严重创伤性脑损伤 (TBI) 住院的服务费索赔 (2014-2015).
- 开发可靠性调整的复合得分,使用30日,90日和365日死亡率,再入院和在家健康日 (HDAH) 的指标.
- 使用体积加权多变量逻辑回归来比较关联与医院级因素.
主要成果:
- 这项研究包括来自1234家医院的573,554名老年人;所有27个出院后的指标都对复合得分有所贡献.
- 综合评分的关键驱动因素是所有创伤患者的30/90天再入院,365天HDAH和365天死亡率.
- 综合得分显示了与医院因素的预期关联 (例如,与质量差相关的体积较低),而医院死亡率显示了反向关联,1级创伤中心的表现最差的几率更高.
结论:
- 仅仅是住院死亡率不足以评估老年人创伤护理的质量.
- 综合分数整合了出院后的指标,提供了更全面和潜在的更准确的医疗质量评估.
- 质量指标的选择显著影响了对老年创伤护理最佳实践的理解.
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