Neumayer L, Mastin M, Vanderhoof L, Hinson D
Veterans Administration Medical Center, Salt Lake City, Utah 84148, USA.
J Surg Res. 2000 Jan;88(1):58-61. doi: 10.1006/jsre.1999.5791.
The primary goal of collecting quality assurance data is to ultimately improve patient care. The VA National Surgical Quality Improvement Program (NSQIP) provides each station with risk-adjusted morbidity and mortality data on a regular basis. This report of one medical center's use of the risk-adjusted data shows how it can be used to improve patient care.
Risk-adjusted surgical outcome data for Fiscal Year 1996 (FY96) was received from the NSQIP coordinating center. The Salt Lake City VA medical center was identified as a high outlier for morbidity in general surgery. Patient charts were reviewed and data analyzed to determine practice patterns and to determine if there were any provider issues. Data analysis revealed a large number of wound complications and uncovered a practice pattern of closure of contaminated wounds. Using these data and data from the literature, wound infection and disruption prevention protocols were instituted in the fall of 1997. Wound complications from January to December 1996 (preprotocol) and January to December 1998 (postprotocol) were compared using Student's t test.
The total number of operations in 1998 was 719 compared with 634 in 1996. Superficial wound infections dropped from 3.6 to 1.7%, while overall wound complications dropped from 5.5 to 2.9%. None of these changes were statistically significant.
Although introduction of wound infection and disruption prevention protocols did not result in a statistically significant decrease in wound complication, it did result in a clinically significant improvement in patient care.
收集质量保证数据的主要目标是最终改善患者护理。退伍军人事务部国家外科质量改进计划（NSQIP）定期向每个站点提供风险调整后的发病率和死亡率数据。本报告展示了一家医疗中心如何使用风险调整后的数据来改善患者护理。
从NSQIP协调中心获取了1996财年（FY96）的风险调整后手术结果数据。盐湖城退伍军人事务部医疗中心被确定为普通外科发病率的高异常值。审查患者病历并分析数据，以确定实践模式并确定是否存在任何医疗服务提供者问题。数据分析发现大量伤口并发症，并发现了污染伤口闭合的实践模式。利用这些数据和文献数据，于1997年秋季制定了伤口感染和裂开预防方案。使用学生t检验比较了1996年1月至12月（方案前）和1998年1月至12月（方案后）的伤口并发症情况。
1998年的手术总数为719例，而1996年为634例。浅表伤口感染率从3.6%降至1.7%，而总体伤口并发症率从5.5%降至2.9%。这些变化均无统计学意义。
虽然引入伤口感染和裂开预防方案并未导致伤口并发症在统计学上显著减少，但确实在临床上显著改善了患者护理。
