Albright J M, Panzer R J, Black E R, Mays R A, Lush-Ehmann C M
Strong Memorial Hospital, University of Rochester Medical Center, NY 14620.
Clin Perform Qual Health Care. 1993 Oct-Dec;1(4):227-32.
To support clinical quality improvement (QI), effective quality analysis tools are essential. New strategies that we have incorporated into our routine assessment activities include comparative screening, clinical process benchmarking tables, and run charts for key quality indicators. To target areas for improvement, we use comparative screening. We have access to clinical data for 11 comparable medical centers. Currently, these data are used to identify our ranking relative to the others for mortality, readmission, and length of stay. Diagnosis-related groups and ICD-9-CM clusters serve as clinical groupings with defined minimal case volume requirements to ensure meaningful comparisons. These comparative reports permit our clinical leaders and hospital administrators to focus QI activities. Clinical process benchmarking involves peer-to-peer interfacility communication to identify those factors that create outstanding clinical performance. We successfully have used this tool to support process improvement in cardiac-surgery, administration of patient controlled analgesia, and respiratory therapy. Interdisciplinary QI teams identify the key investigative questions. Team members then contact their counterparts at similar facilities, which differ from our hospital in quality, based on empirical evidence or through comparative screening. The information that is obtained is collated in a tabular format, along with our own information, to permit easy identification of key clinical processes associated with better outcomes. Key quality and utilization goals at our hospital include reducing unplanned readmissions by 10%, achieving a 5% lower average length of stay, and not exceeding Health Care Financing Administration expected mortality rates in any clinical area.(ABSTRACT TRUNCATED AT 250 WORDS)
为支持临床质量改进（QI），有效的质量分析工具至关重要。我们纳入日常评估活动的新策略包括比较筛查、临床流程基准表以及关键质量指标的运行图。为确定改进领域，我们使用比较筛查。我们可获取11家可比医疗中心的临床数据。目前，这些数据用于确定我们在死亡率、再入院率和住院时间方面相对于其他中心的排名。诊断相关组和ICD - 9 - CM分类作为临床分组，有明确的最小病例量要求，以确保有意义的比较。这些比较报告使我们的临床负责人和医院管理人员能够专注于质量改进活动。临床流程基准制定涉及机构间的对等沟通，以确定那些造就卓越临床绩效的因素。我们已成功使用此工具来支持心脏手术、患者自控镇痛管理及呼吸治疗方面的流程改进。跨学科质量改进团队确定关键调查问题。然后，团队成员根据经验证据或通过比较筛查，联系质量与我们医院不同的类似机构的同行。所获取的信息与我们自己的信息一起以表格形式整理，以便轻松识别与更好结果相关的关键临床流程。我们医院的关键质量和利用目标包括将非计划再入院率降低10%，平均住院时间缩短5%，且在任何临床领域不超过医疗保健财务管理局预期的死亡率。（摘要截选于250词）
