2009年至2021年荷兰ICU的质量改善:基于注册表的观察性研究
Marie-José Roos-Blom1, Ferishta Bakhshi-Raiez1, Sylvia Brinkman1
1Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
荷兰重症监护室 (ICU) 的质量在关键指标上从2009-2019年大幅改善. 随着COVID-19的流行,这种趋势被打破了,尽管整体ICU之间的质量变化保持稳定.
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
- 提高质量 提高科学 提高质量
背景情况:
- 荷兰国家重症监护评估 (NICE) 注册表提供了一个强大的数据集,用于监测重症监护单位 (ICU) 的质量.
- 评估ICU质量指标的趋势对于了解随时间推移的医疗保健系统绩效至关重要.
研究的目的:
- 评估2009年至2021年期间荷兰ICU护理质量的演变.
- 确定特定质量指标的变化,并分析ICU之间的异质性.
主要方法:
- 在NICE注册表中使用了55个ICU (符合条件的65%) 的数据,包括2009-2021年705,822个ICU入院情况.
- 进行了多层次回归分析,以评估八个质量指标的变化,包括和不包括COVID-19流行年 (2020-2021年).
- 为每个指标量化ICU之间的异质性,计算了类内相关系数 (ICC).
主要成果:
- 在2009年至2019年期间,在ICU停留时间 (LOS),机械呼吸 (MV) 持续时间,再入院,住院死亡率,低血糖和压力方面观察到显著改善.
- 包括COVID-19流行年 (2020-2021) 减少了观察到的MV持续时间,ICU LOS和压力发病率的显著改善.
- 在整个研究期间,ICU之间的异质性通常很低 (ICC ≤0.07),除了压力 (ICC=0.27),在整个研究期间.
结论:
- 荷兰ICU护理质量,通过7个指标衡量,显示2009年至2019年的显著改善,通常在ICU之间小到中等的变化,除了压力.
- 虽然COVID-19大流行暂时打断了质量改善的积极趋势,但并没有改变ICU之间潜在的异质性.
- 这些发现突显了外部事件对医疗保健质量指标的影响,并强调了持续监测和有针对性的干预措施的必要性.
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