在医疗保健中重新考虑措施和死亡率归因:糖尿病和内分泌学例子
Lorenzo Olivero1,2, Jorge Sinclair1,3, Trisha Singh1,4,5
1Department of Critical Care, Mayo Clinic, Jacksonville, FL.
Mayo Clinic proceedings. Innovations, quality & outcomes
|September 19, 2024
概括
美国新闻和世界报道 (USNWR) 的糖尿病和内分泌学排名可能错误地归因患者的死亡. 大多数死亡是由于癌症或无法壮成长,而不是内分泌问题,质疑排名.
科学领域:
- 内分泌学 在内分泌学.
- 医疗质量评估 医疗质量评估
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医院排名,例如美国新闻和世界报道 (USNWR) 的医院排名,影响患者的选择和机构声誉.
- 关于死亡率归因,USNWR糖尿病和内分泌学专业排名方法不透明.
- 准确的死亡率归因对于评估医疗保健质量和患者结果至关重要.
研究的目的:
- 评估美国新闻和世界报道 (USNWR) 针对糖尿病和内分泌学专业的死亡率归因的准确性.
- 为了比较USNWR所归因的死亡原因与临床医生判断的死亡原因在现实世界患者队列中.
主要方法:
- 佛罗里达州梅奥诊所连续医疗保险收费住院患者的回顾性审查,入院后30天内死亡率.
- 纳入标准侧重于与USNWR糖尿病和内分泌学队列 (2018年11月至2022年4月) 相关的Medicare严重性诊断相关组中的患者.
- 一位临床医生判断了死亡的主要原因,将其分类为糖尿病/内分泌,癌症,发育不良或其他.
主要成果:
- 在49名死亡患者中,只有7人 (14.3%) 的首要死亡原因与糖尿病或内分泌疾病有关.
- 癌症是导致死亡的主要原因 (49.0%),其次是无法壮成长 (30.6%).
- 在USNWR的暗示归因与实际死亡原因之间观察到86%的显著差异.
结论:
- 在糖尿病和内分泌学专业中,USNWR用于归因死亡率的方法似乎不准确,错误归因率很高.
- 这种差异引发了人们对USNWR排名在评估糖尿病和内分泌学护理质量的可靠性的担忧.
- 误导性医院排名可能会对患者的决策和机构声誉产生负面影响.
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