Roberts C M, Lowe D, Bucknall C E, Ryland I, Kelly Y, Pearson M G
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
Thorax. 2002 Feb;57(2):137-41. doi: 10.1136/thorax.57.2.137.
The 1997 BTS/RCP national audit of acute chronic obstructive pulmonary disease (COPD) in terms of process of care has previously been reported. This paper describes from the same cases the outcomes of death, readmission rates within 3 months of initial admission, and length of stay. Identification of the main pre-admission predictors of outcome may be used to control for confounding factors in population characteristics when comparing performance between units.
Data on 74 variables were collected retrospectively using an audit proforma from patients admitted to UK hospitals with acute COPD. Important prognostic variables for the three outcome measures were identified by relative risk and logistic regression was used to place these in order of predictive value.
1400 admissions from 38 acute hospitals were collated. 14% of cases died within 3 months of admission with variation between hospitals of 0-50%. Poor performance status, acidosis, and the presence of leg oedema were the best significant independent predictors of death. Age above 65, poor performance status, and lowest forced expiratory volume in 1 second (FEV(1)) tertile were the best predictors of length of stay (median 8 days). 34% of patients were readmitted (range 5-65%); lowest FEV(1) tertile, previous admission, and readmission with five or more medications were the best predictors for readmission.
Important predictors of outcome have been identified and formal recording of these may assist in accounting for confounding patient characteristics when making comparisons between hospitals. There is still wide variation in outcome between hospitals that remains unexplained by these factors. While some of this variance may be explained by incomplete recording of data or patient factors as yet unidentified, it seems likely that deficiencies in the process of care previously identified are responsible for poor outcomes in some units.
1997年英国胸科学会/皇家内科医师学会针对急性慢性阻塞性肺疾病（COPD）护理过程开展的全国性审计报告已发表。本文从相同病例中描述了死亡结局、首次入院后3个月内的再入院率以及住院时间。确定主要的入院前结局预测因素，可用于在比较各单位绩效时控制人群特征中的混杂因素。
采用审计表格，对英国医院收治的急性COPD患者进行回顾性数据收集，共收集74个变量的数据。通过相对风险确定这三项结局指标的重要预后变量，并采用逻辑回归按预测价值对这些变量进行排序。
整理了来自38家急症医院的1400例入院病例。14%的病例在入院后3个月内死亡，各医院之间的差异为0%至50%。身体状况差、酸中毒和腿部水肿是死亡的最佳显著独立预测因素。65岁以上、身体状况差以及第1秒用力呼气量（FEV(1)）处于最低三分位数是住院时间（中位数8天）的最佳预测因素。34%的患者再次入院（范围为5%至65%）；FEV(1)处于最低三分位数、既往入院以及使用五种或更多药物再次入院是再次入院的最佳预测因素。
已确定了结局的重要预测因素，正式记录这些因素可能有助于在医院间进行比较时考虑混杂的患者特征。医院之间的结局仍存在很大差异，这些因素无法解释这些差异。虽然部分差异可能是由于数据记录不完整或尚未识别的患者因素所致，但先前确定的护理过程中的缺陷似乎是某些单位结局不佳的原因。
