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病例采样用于评估美国手术质量改进计划中的医院术后发病率
Vivi W Chen1,2, Tracey Rosen1, Yongquan Dong1
1Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas.
JAMA surgery
|December 27, 2023
概括
使用病例采样进行的外科质量改进计划可能会错过许多患有高术后并发症率的医院. 对所有病例的普遍审查对于识别异常医院和提高患者安全更为强大.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善外科手术的质量
- 患者安全 患者安全
背景情况:
- 美国的外科质量改善 (QI) 计划经常使用数据采样来评估医院术后并发症率.
- 并发症和采样方法的下降趋势引发了人们对识别异常医院的稳定性的担忧.
研究的目的:
- 为了比较采样策略与普遍病例审查在确定医院30天并发症率方面的有效性.
- 评估当前采样方法在改善外科手术质量的可靠性.
主要方法:
- 美国医院一级的分析比较了风险调整后的30天并发症观察到预期 (O-E) 比率,使用样本 (n=502,730) 与非心脏手术病例的普遍审查 (n=1,725,364).
- 医院被确定为异常值,如果他们的OE比率明显大于1.0.0.
主要成果:
- 在样本队列 (7.6%) 中,整体30天并发症率高于普遍审查队列 (5.3%).
- 案例抽样在15.0%的季度中发现了异常医院,而通用审查在18.2%中发现了异常医院.
- 通过普遍审查确定的异常医院病房中,不到一半的病例采样同时被确定.
结论:
- 在外科手术质量改进计划中的病例抽样发现不到一半的医院有过多的风险调整后术并发症.
- 需要进行进一步的研究,以优化数据收集和利用,以便有效地提高当地质量.
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