Iezzoni L I, Davis R B, Palmer R H, Cahalane M, Hamel M B, Mukamal K, Phillips R S, Banks N J, Davis D T
Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Int J Qual Health Care. 1999 Apr;11(2):107-18. doi: 10.1093/intqhc/11.2.107.
The Complications Screening Program (CSP) aims to identify 28 potentially preventable complications of hospital care using computerized discharge abstracts, including demographic information, diagnosis and procedure codes.
To validate the CSP as a quality indicator by using explicit process of care criteria to determine whether hospital discharges flagged by the CSP experienced more process problems than unflagged discharges.
The (CSP was applied to computerized hospital discharge abstracts from Mledicare beneficiaries > 65 years old admitted in 1994 to hospitals in California and Connecticut for major surgery or medical treatment. ()f 28 CSP complications, 17 occurred sufficient frequently to study. Discharges flagged (cases) and unflagged (controls) by the (CSP were sampled and photocopied medical records were obtained. Physicians specified detailed, objective, explicit criteria, itemizing 'key steps' in processes of care that could potentially have prevented or caused complications. Trained nurses abstracted medical records using these explicit criteria. Process problem rates between cases and controls were compared.
The final sample included 740 surgical and 416 medical discharges. Rates of process problems were high, ranging from 24.4 to 82.5% across CSP screens for surgical cases. Problems were lower for medical cases, ranging from 2.0 to 69.1% across CSP screens. Problem rates were 45.7% for surgical and 5.0% for medical controls. Rates of problems did not differ significantly across flagged and unflagged discharges.
The CSP did not flag discharges with significantly higher rates of explicit process problems than unflagged discharges. Various initiatives throughout the USA use techniques similar to the CSP to identify complications of care. Based on these CSP findings, such approaches should be evaluated cautiously.
并发症筛查项目（CSP）旨在利用计算机化出院摘要（包括人口统计学信息、诊断和程序编码）识别28种可能可预防的医院护理并发症。
通过使用明确的护理流程标准来确定CSP标记的医院出院病例是否比未标记的出院病例经历更多的流程问题，从而验证CSP作为一种质量指标。
CSP应用于1994年入住加利福尼亚州和康涅狄格州医院接受大手术或治疗的65岁以上医疗保险受益人的计算机化医院出院摘要。在CSP的28种并发症中，有17种发生频率足够高，可以进行研究。对CSP标记的（病例）和未标记的（对照）出院病例进行抽样，并获取复印的病历。医生制定了详细、客观、明确的标准，列出了护理过程中可能预防或导致并发症的“关键步骤”。经过培训的护士使用这些明确的标准提取病历。比较病例组和对照组之间的流程问题发生率。
最终样本包括740例外科出院病例和416例内科出院病例。外科病例的CSP筛查中流程问题发生率很高，范围从24.4%到82.5%。内科病例的问题发生率较低，CSP筛查中的范围从2.0%到69.1%。外科对照组的问题发生率为45.7%，内科对照组为5.0%。标记和未标记的出院病例之间的问题发生率没有显著差异。
CSP标记的出院病例的明确流程问题发生率并不显著高于未标记的出院病例。美国各地的各种举措都使用类似于CSP的技术来识别护理并发症。基于这些CSP的研究结果，应谨慎评估此类方法。
