医院间护理质量指标的变化:系统性审查
Margrietha van der Linde1, Nèwel Salet2, Nikki van Leeuwen3
1Department of Public Health, Erasmus MC, Rotterdam, The Netherlands m.vanderlinde@erasmusmc.nl.
BMJ quality & safety
|February 23, 2024
概括
医院在质量指标上的变化通常很小,但对护理过程来说很重要. 分析根据水平和指标的变化是有效的质量改进战略的关键.
科学领域:
- 医疗保健质量研究研究
- 医疗服务研究 医疗服务研究
- 医学变异分析 (MVA)
背景情况:
- 了解医疗保健质量的变化对于改善工作至关重要.
- 确定变化的水平 (患者,医生,病房,医院) 是必要的.
- 本综述综合了量化医院对质量指标变化贡献的研究.
研究的目的:
- 系统地审查和综合有关医院之间质量指标得分差异程度的证据.
- 分析不同疾病类别和质量指标类型之间的这种变化.
主要方法:
- 在Embase,Medline,科学网,Cochrane和谷歌学者 (2010-2023) 的系统文献搜索.
- 包括报告医院间变异的研究 (变异分割系数 - VPC).
- 根据疾病类别和质量指标类型 (中间/最终结果,过程,患者经验/结果) 分层分析.
主要成果:
- 44项研究符合纳入标准,分析了144个指标.
- 医院归因的变化 (VPC) 的中位数为3% (IQR为1%-9%).
- 过程指标的变化最高 (中位数为17.4%),最终临床结果 (中位数为1.4%) 和患者报告结果 (中位数为1.0%) 的变化最低.
结论:
- 与残留变化相比,质量指标的医院级变化通常很小.
- 对于特定指标,特别是受医院政策影响的护理流程,医院存在显著的差异.
- 建议对特定水平和特定指标进行分析,考虑绝对变化,以实现具有影响力的质量改进.
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