对心脏手术后术后死亡率的风险调整持续监测
Zahra Mobini1, Ammer Saati2, Turgay Ayer3
1Scheller College of Business, Georgia Tech, Atlanta, Georgia, USA.
Health services research
|March 19, 2025
概括
使用风险调整累积总和 (CUSUM) 进行持续监测,比标准的插曲性评估更早地确定了心脏手术死亡率高于预期的医院. 这使得更快的干预能够防止患者受到伤害.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
- 外科手术的结果
背景情况:
- 识别高术后死亡率的医院的传统方法通常涉及延迟分析.
- 及时检测心脏手术结果的不良趋势对于患者安全至关重要.
- 现有的质量改进 (QI) 计划在数据报告中面临时间滞后.
研究的目的:
- 为了比较持续风险调整累积总和 (CUSUM) 监测与标准情节性评估对心脏手术后检测高于预期的术后死亡率的有效性.
- 通过这两种方法来评估表现不佳的医院的识别时间.
主要方法:
- 一项国家级,观察性,医院级的研究利用了退伍军人事务外科质量改善计划 (VASQIP) 2016-2020年的数据.
- 将风险调整后累计总和 (CUSUM) 与标准情节性评估 (观察到预期[O-E]比率) 进行比较,以确定季度死亡率较高的医院.
- 在20个季度内分析了41家退伍军人事务医院接受心脏手术的20927名成年患者的数据.
主要成果:
- 连续CUSUM发现3.8%的医院病房的死亡率高于预期,相比之下,1.8%的病例性O-E比率.
- 通过这两种方法识别的医院在使用CUSUM时平均提前17天被检测出来.
- CUSUM早些时候确定了死亡率较高的医院,允许在平均12例手术病例和71个住院日之前进行潜在干预.
结论:
- 与情节分析相比,风险调整累积和 (CUSUM) 可以更早地检测心脏外科手术中术后死亡率较高的医院.
- 在国家质量改进工作中,CUSUM是实时绩效监测的宝贵工具,有助于及时干预.
- 平衡敏感性和错误信号是有效实施CUSUM在QI倡议中以防止患者受到伤害的关键.
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