医院质量指标在时间上的稳定性:对德国医院数据的多年观察研究
Nils Patrick Kollmann1, Benedikt Langenberger2, Reinhard Busse2
1Helios IT Service GmbH, Berlin, Germany.
PloS one
|November 7, 2023
概括
医院质量指标显示出随着时间的推移显著的稳定性,支持其在公共报告中的使用. 这种稳定性因指标和治疗领域而异,为政策干预提供了信息.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策分析 卫生政策分析
- 提高质量 提高科学 提高质量
背景情况:
- 医院质量指标 (HQI) 必须是当前或未来医疗保健质量的可靠信号.
- 由于对其时间稳定性的研究有限,人们对HQI的有用性持怀疑态度.
- 公共报告举措在很大程度上依赖于HQI的可信度随着时间的推移.
研究的目的:
- 评估综合的医院级质量指标的时间稳定性.
- 加强评估HQI稳定性的方法基础.
- 根据HQI稳定性,对健康政策产生影响.
主要方法:
- 对所有德国医院 (2004-2017) 的两个纵向数据集 (自我报告和常规数据) 的分析.
- 逻辑回归与通用估计方程的应用.
- 利用时间依赖的图形五分位数表示和斯皮尔曼的等级相关系数.
主要成果:
- 德国的8个质量指标显示,随着时间的推移,其稳定性显著.
- 保持在顶级质量集群中的概率在46.9% (关节置换术) 到80.4% (关节置换术) 之间.
- 在表现最好和表现最差的医院之间,不良事件发生率差异持续至少两年,因指标而异.
结论:
- 医院质量指标具有足够的时间稳定性,可以有效地向公众报告.
- 增加案件数量和集中化等因素可能会提高指标可靠性.
- 政策干预,如基于结果的支付,应优先考虑具有证明高稳定的指标.
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