Tu Jack V, Cameron Cathy
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Int J Qual Health Care. 2003 Apr;15(2):131-7. doi: 10.1093/intqhc/mzg015.
Acute myocardial infarction (AMI) 'report cards' are being developed using administrative databases in many jurisdictions, but little is known about their acceptance by and their usefulness to the medical community. The purpose of this study was to determine the impact of the publication of Cardiovascular Health and Services in Ontario: An ICES Atlas (Naylor CD, Slaughter P. (eds), 1999, Toronto: ICES), the first report featuring hospital-specific AMI performance measures to be published in Canada.
We conducted a mail survey of physicians at Ontario hospitals to determine their views on the usefulness of various atlas performance measures for assessing and improving quality of care, the types of quality initiatives launched at their hospital in response to the atlas, and their views on the concept and limitations of reporting hospital-specific AMI mortality data.
Respondents to the survey indicated that information on process of care measures such as post-infarction beta-blocker and angiotensin-converting enzyme (ACE) inhibitor use, and cardiac procedure waiting times were the most useful, and outcomes data (e.g. 30-day and 1-year risk-adjusted AMI mortality rates) the least useful of the multiple performance measures published in the atlas (P = 0.0385). Fifty-four percent of respondents reported launching one or more quality of care initiatives at their hospital in response to the atlas. The majority of respondents (65%) indicated that they support the public release of hospital-specific AMI mortality data, although many had concerns about potential miscoding in administrative databases and the adequacy of risk-adjustment methods.
The publication of the first AMI report card in Canada stimulated quality of care initiatives at many Ontario hospitals. Inclusion of performance measures other than mortality in health care report cards may lead to greater acceptance and use by the medical community.
在许多司法管辖区，急性心肌梗死（AMI）“成绩单”正利用行政数据库编制，但对于医学界对其接受程度及实用性知之甚少。本研究旨在确定《安大略省心血管健康与服务：一份ICES地图集》（内勒CD、斯劳特P编，1999年，多伦多：ICES）的出版所产生的影响，这是加拿大出版的首份以医院特定AMI绩效指标为特色的报告。
我们对安大略省各医院的医生进行了邮件调查，以确定他们对各种地图集绩效指标在评估和改善医疗质量方面的有用性的看法、他们所在医院针对该地图集发起的质量改进举措的类型，以及他们对报告医院特定AMI死亡率数据的概念和局限性的看法。
调查受访者表示，梗死后期β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂使用情况以及心脏手术等待时间等护理过程指标信息最为有用，而地图集中公布的多项绩效指标中，结果数据（如30天和1年风险调整后的AMI死亡率）最无用（P = 0.0385）。54%的受访者报告称，他们所在医院针对该地图集发起了一项或多项医疗质量改进举措。大多数受访者（65%）表示支持公开医院特定的AMI死亡率数据，尽管许多人担心行政数据库中可能存在编码错误以及风险调整方法是否充分。
加拿大首份AMI成绩单的发布在安大略省许多医院激发了医疗质量改进举措。在医疗保健成绩单中纳入死亡率以外的绩效指标可能会导致医学界更大程度的接受和使用。
