Lindsay Patrice, Schull Michael, Bronskill Susan, Anderson Geoffrey
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Acad Emerg Med. 2002 Nov;9(11):1131-9. doi: 10.1111/j.1553-2712.2002.tb01567.x.
To develop and apply a systematic approach to identify and define valid, relevant, and feasible measures of emergency department (ED) clinical performance.
An extensive literature review was conducted to identify clinical conditions frequently treated in most EDs, and clinically relevant outcomes to evaluate these conditions. Based on this review, a set of condition-outcome pairs was defined. An expert panel was convened and a Modified-Delphi process was used to identify specific condition-outcome pairs where the panel felt there was a link between quality of care for the condition and a specific outcome. Next, for highly rated condition-outcome pairs, specific measurable indicators were identified in the literature. The panelists rated these indicators on their relevance to ED performance and need for risk adjustment. The feasibility of calculating these indicators was determined by applying them to a routinely collected data set.
Thirteen clinical conditions and eight quality-of-care outcomes (mortality, morbidity, admissions, recurrent visits, follow-up with primary care, length of stay, diagnostics, and resource use) were identified from the literature (104 pairs). The panel selected 21 condition-outcome pairs, representing eight of 13 clinical conditions. Then, the panel selected 29 specific clinical indicators, representing the condition-outcome pairs, to measure ED performance. It was possible to calculate eight of these indicators, covering five clinical conditions, using a routinely collected data set.
Using a Modified-Delphi process, it was possible to identify a series of condition-outcome pairs that panelists felt were potentially related to ED quality of care, then define specific indicators for many of these condition-outcome pairs. Some indicators could be measured using an existing data set. The development of sound clinical performance indicators for the ED is possible, but the feasibility of measuring them will be dependent on the availability and accessibility of high-quality data.
制定并应用一种系统方法，以识别和定义急诊科（ED）临床绩效的有效、相关且可行的衡量指标。
进行广泛的文献综述，以确定大多数急诊科经常治疗的临床病症，以及评估这些病症的临床相关结局。基于此综述，定义了一组病症-结局对。召集了一个专家小组，并采用改良德尔菲法来识别专家小组认为在病症护理质量与特定结局之间存在关联的特定病症-结局对。接下来，对于评分较高的病症-结局对，在文献中确定具体的可衡量指标。小组成员对这些指标与急诊科绩效的相关性以及风险调整需求进行评分。通过将这些指标应用于常规收集的数据集来确定计算这些指标的可行性。
从文献（104对）中确定了13种临床病症和8种护理质量结局（死亡率、发病率、住院、复诊、初级保健随访、住院时间、诊断和资源使用）。专家小组选择了21对病症-结局对，代表13种临床病症中的8种。然后，专家小组选择了29个具体的临床指标，代表这些病症-结局对，以衡量急诊科绩效。使用常规收集的数据集可以计算其中8个指标，涵盖5种临床病症。
通过改良德尔菲法，有可能识别出专家小组认为可能与急诊科护理质量相关的一系列病症-结局对，然后为其中许多病症-结局对定义具体指标。一些指标可以使用现有数据集进行测量。为急诊科制定合理的临床绩效指标是可行的，但衡量这些指标的可行性将取决于高质量数据的可用性和可获取性。
