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改善紧急整体外科的结果:构建一个协作质量倡议的构建
Mark R Hemmila1, Pooja U Neiman, Beckie L Hoppe
1From the Department of Surgery (M.R.H., B.L.H., L.G., K.A.K., J.L.J., J.N.M., J.W.S., L.M.N.), University of Michigan Medical School; Center for Healthcare Outcomes and Policy (M.R.H., P.U.N., L.G., J.W.S.), and National Clinical Scholars Program (P.U.N.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (P.U.N.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (A.Y.Y.), Corewell Health, Grand Rapids; Department of Surgery (H.J.L.), Sparrow Health System, Lansing; Department of Surgery (R.J.G.), Trinity Health Ann Arbor, Ann Arbor; and Department of Surgery (E.J.M.), University of Michigan Health-West, Wyoming, Michigan.
紧急整体外科护理显示出高发病率和显著的医院变异. 质量改善举措可以识别和解决这些异常值,以优化患者的治疗结果.
科学领域:
- 改善外科手术的质量
- 卫生系统研究 卫生系统研究
- 患者的治疗结果.
背景情况:
- 紧急通用外科 (EGS) 条件是普遍的,昂贵的,并与高发病率相关.
- 了解卫生系统变化对EGS发病率的影响至关重要.
- 建立了一个协作质量倡议,以调查EGS护理和推动流程改进.
研究的目的:
- 评估 EGS 护理流程和多家医院患者治疗结果的变化.
- 在风险调整后,在EGS护理中识别高和低绩效的医院.
- 评估协作质量改进工作在优化EGS成果方面的潜力.
主要方法:
- 2019年7月至2022年12月期间从10家医院收集的数据.
- 对五个队伍的分析:急性尾炎,急性胆囊疾病,小肠阻塞,紧急腹腔切除术和总体.
- 研究的手术与非手术管理,死亡率,发病率,再录取和停留时间,并进行多变量风险调整.
主要成果:
- 包括19956名EGS患者;调整后的总死亡率为3.5%,发病率为27.6%,再接收率为15.1%.
- 在手术管理 (例如,尾炎70.9%-96.9%),胃镜使用 (10.7%-61.4%) 和胆囊静脉管放置 (23.5%-62.1%) 中观察到显著的医院间变化.
- 风险调整后的结果显示了医院之间的显著差异,确定了死亡率,发病率和再入院的异常值.
结论:
- 一个多医院的EGS协作确定了护理过程和结果的实质性变化.
- 在不同机构的EGS中,高发病率仍然存在.
- 有针对性的质量改进工作在识别异常值和优化EGS患者结果方面是有效的.
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