延迟静脉血栓栓塞的诊断和死亡风险
Min-Jeoung Kang1,2, Richard Schreiber3, Veysel Karani Baris1,4
1Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA network open
|September 26, 2025
概括
观察到静脉血栓塞栓症 (VTE) 的诊断延迟率很高,延迟诊断显著增加死亡风险. DOVE eCQM工具可以帮助提高VTE诊断的质量.
科学领域:
- 医疗信息学 医疗信息学
- 临床质量测量临床质量测量
- 公共卫生 公共卫生
背景情况:
- 静脉血栓栓塞 (VTE) 的非特异性症状使早期检测复杂化.
- 目前缺乏用于监测VTE诊断延迟的自动化工具.
- 及时诊断VTE对于患者的治疗结果至关重要.
研究的目的:
- 为了评估两种不同的EHRs的两个医疗保健系统的VTE (DOVE) 诊断延迟率.
- 为了分类错过VTE诊断的原因.
- 评估诊断延迟与30天全因死亡率之间的关联.
主要方法:
- 从大众医院布里格姆 (MGB) 和宾夕法尼亚州立卫生局 (PSH) 收集的电子健康记录 (EHR) 数据的回顾性分析.
- 开发和应用电子临床质量测量 (eCQM) 来量化DOVE.
- 及时 (≤24小时) 和延迟 (>24小时) VTE诊断之间的30天全因死亡率的比较.
主要成果:
- 观察到高的DOVE率:79.43% (MGB) 和82.38% (PSH) 使用超过24小时的门.
- 与医生相关的因素是诊断延迟的最常见原因.
- 推迟VTE诊断与30天全因死亡率的增加有关 (RR 3.31在MGB;RR 1.28在PSH).
结论:
- 持续高的DOVE率表明,在及时诊断VTE方面存在重大挑战.
- DOVE eCQM 工具对于识别和解决诊断延迟非常有价值.
- 实施DOVE eCQM可以支持多个医疗保健层面的质量改善倡议.
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