Johansen Bendt, Mainz Jan, Sabroe Svend, Manniche Claus, Leboeuf-Yde Charlotte
Medical Research Unit in the County of Ringkoebing, Ringkoebing, Denmark.
Spine (Phila Pa 1976). 2004 Apr 15;29(8):925-31. doi: 10.1097/00007632-200404150-00021.
Prospective cohort study.
To develop clinical indicators and standards in an outpatients' department for sub acute low back pain patients.
A systematic quantitative surveillance to assess quality of care was implemented using outcome and performance measures. These measures were developed within the framework of Health Technology Assessment, which comprises the areas of healthcare technology, patient, organization, and economy.
A multidisciplinary project group defined 1) clinical indicators in terms of outcome and performance measures and 2) the corresponding standards using the available evidence from literature. Observed outcomes were compared with the standards. Associations between process and outcome measures were investigated.
A total of 300 patients were included consecutively. In relation to technology, the standards for the field of application were fulfilled (e.g., not too many patients were x-rayed). With respect to effectiveness, the observed rate of patients reaching a 50% cutoff point of improvement of pain and function did not fulfill the standards. In relation to patient aspects, the standards of, for example, proper understanding of patient education and satisfaction, were fulfilled. In relation to organization, nearly one third of the patients were referred later to the department than the recommended 24 weeks. This refer variable showed an association to a reduced chance of scoring "better" or "much better" in "patients global assessment." The chance was reduced by 50% if patients were referred later than 12 weeks after onset of pain. In relation to economy, the cost of gaining a quality adjusted life-year by a course in the department was considerably lower than by comparison with total hip arthroplasty.
Surveillance by clinical indicators in relation to the four areas of health technology assessment provides quantitative information that is meaningful for various stakeholders on important aspects of the quality of care (including consumers), provides a basis for quality improvement, and provides data for analysis of possible important relationships between structure, process, and outcome.
前瞻性队列研究。
为门诊亚急性下背痛患者制定临床指标和标准。
采用结局指标和绩效指标实施了一项系统性定量监测，以评估医疗质量。这些指标是在卫生技术评估框架内制定的，该框架涵盖医疗技术、患者、组织和经济等领域。
一个多学科项目组根据结局指标和绩效指标定义了1）临床指标，以及2）使用文献中的现有证据确定了相应标准。将观察到的结局与标准进行比较。研究了过程指标和结局指标之间的关联。
共连续纳入300例患者。在技术方面，应用领域的标准得到满足（例如，接受X光检查的患者数量不过多）。在有效性方面，达到疼痛和功能改善50%临界点的患者观察率未达到标准。在患者方面，例如对患者教育的正确理解和满意度等标准得到满足。在组织方面，近三分之一的患者转诊至该科室的时间比推荐的24周晚。这个转诊变量显示与在“患者总体评估”中获得“更好”或“好得多”评分的机会降低有关。如果患者在疼痛发作后12周后转诊，该机会会降低50%。在经济方面，该科室一个疗程获得一个质量调整生命年的成本比全髋关节置换术低得多。
与卫生技术评估的四个领域相关的临床指标监测提供了对包括消费者在内的各利益相关者来说在医疗质量重要方面有意义的定量信息，为质量改进提供了基础，并为分析结构、过程和结局之间可能的重要关系提供了数据。
