一种多维的方法来识别美国各地的高性能创伤中心
Doulia M Hamad1, Haris Subacius, Arielle Thomas
1From the Department of Surgery (D.M.H., M.P.G., B.H., A.B.N.), Sunnybrook Health Sciences Center and the University of Toronto; Institute of Health Policy, Management, and Evaluation (D.M.H., A.B.N.), University of Toronto, Toronto, Ontario, Canada; The Society of Thoracic Surgeons (H.S.), Chicago, Illinois; Medical College of Wisconsin (A.T.), Milwaukee, Wisconsin; Interdepartmental Division of Critical Care (B.W.T., B.H.), University of Toronto; Tory Trauma Program (B.W.T., A.B.N.), Sunnybrook Health Sciences Center; Department of Medicine (B.W.T.), Division of Respirology and Critical Care Medicine, University Health Network; Sunnybrook Research Institute (B.W.T., A.J., B.H., A.B.N.), Sunnybrook Health Sciences Centre; Department of Anesthesia (A.J.), Sunnybrook Health Sciences Center University of Toronto; Department of Critical Care Medicine (B.H.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and American College of Surgeons (A.B.N.), Chicago, Illinois.
高效的创伤中心在患者安全和质量方面表现出色,通过I级状态和高患者数量等结构要素. 这些中心的死亡率和并发症率明显降低,改善了整体创伤护理结果.
科学领域:
- 创伤外科 手术 创伤外科
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
背景情况:
- 创伤中心的表现受结构和文化因素的影响.
- 确定关键的差异化因素对于优化创伤护理质量至关重要.
- 这项研究侧重于高性能创伤中心的结构特征.
研究的目的:
- 将五个质量指标结合起来,为创伤中心提供综合评分.
- 识别和描述一贯高性能创伤中心的结构特征.
- 评估创伤质量的各个领域的表现.
主要方法:
- 利用美国外科医生学院创伤质量改善计划数据 (2017-2020).
- 评估了五个质量指标:OR的时间,静脉血栓塞栓症预防,救援失败,重大并发症和死亡率.
- 采用主要组件分析来验证综合绩效评分.
主要成果:
- 高性能中心的死亡率,严重并发症和救援失败率显著降低 (p < 0.001).
- 枪伤患者到手术室的中位时间减少了一半,在顶级中心,及时的VTE预防率增加了一倍以上.
- 顶级中心更有可能是I级,并管理大量严重受伤的患者.
结论:
- 综合质量评分有效地区分创伤中心.
- 像I级状态和高创伤中心体积这样的结构元素与卓越的性能有关.
- 结合多个质量指标,建立了一个更高的标准来评估创伤中心的有效性.
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