Wakefield D S, Pfaller M, Ludke R L, Wenzel R P
Graduate Program in Hospital and Health Administration, University of Iowa, Iowa City 52242.
Med Care. 1992 Apr;30(4):373-6. doi: 10.1097/00005650-199204000-00007.
While there is little agreement at the individual patient level of analysis, estimates of mean NI-attributed days of stay for the two methods were essentially the same. The lack of agreement at the individual patient level may reflect fundamental differences in the methods used to derive these estimates: incorporation of noninfected patient data versus exclusive reliance on data from infected patients; and, focus on length of stay rather than the actual care being received. The potential advantages of the AEP-based method include the following: 1) all patients with NI can be included in developing estimates; 2) estimates are based on the care provided rather than simple length of stay differences; 3) data on which to form the NI-day estimates are readily available in the medical record; 4) the AEP is a validated and commonly used utilization review instrument; 5) the AEP-based method has acceptable reliability; 6) this method is designed to provide individual and group estimates of NI-attributed days; 7) because every day of stay is reviewed, additional information is available, which results in greater precision of study of the development, diagnosis, and treatment of the NI relative to the other care that originally brought the patient into the hospital. The AEP-based method for estimating NI-days is a promising alternative to the historical cohort approach. Additional applications of this approach are encouraged to further assess its reliability,validity, and additional information yield.
虽然在个体患者层面的分析上几乎没有达成共识，但两种方法对平均归因于医院感染的住院天数的估计基本相同。在个体患者层面缺乏一致性可能反映了用于得出这些估计值的方法存在根本差异：纳入未感染患者的数据与仅依赖感染患者的数据；以及关注住院时间而非实际接受的护理。基于急性生理与慢性健康状况评分系统（AEP）的方法的潜在优势包括以下几点：1）所有医院感染患者都可纳入估计值的制定；2）估计值基于所提供的护理而非简单的住院时间差异；3）形成医院感染天数估计值的数据在病历中很容易获得；4）急性生理与慢性健康状况评分系统是一种经过验证且常用的利用情况审查工具；5）基于急性生理与慢性健康状况评分系统的方法具有可接受的可靠性；6）该方法旨在提供个体和群体的医院感染归因天数估计值；7）由于对住院的每一天都进行审查，可获得更多信息，这使得相对于最初导致患者入院的其他护理，对医院感染的发生、诊断和治疗的研究更加精确。基于急性生理与慢性健康状况评分系统的医院感染天数估计方法是历史队列研究方法的一种有前景的替代方法。鼓励进一步应用这种方法来进一步评估其可靠性、有效性和额外信息产出。
