Pope Karla Rae, Hancock John S, Sills Eric Scott
Department of Obstetrics and Gynecology, St. Matthew's University College of Medicine, Grand Cayman, British West Indies.
Health Res Policy Syst. 2006 Mar 29;4:3. doi: 10.1186/1478-4505-4-3.
To survey management of selected emergency healthcare needs in a Tennessee community hospital.
In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC) in Harriman, Tennessee (pop. 6,757). Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI), heart failure, and pneumonia during the 14 month interval ending March 2005. The data also permitted comparisons with state and national reference groups.
Of RMC patients with myocardial infarction (MI), 94% received aspirin on arrival, a figure higher than both state (85%) and national (91%) averages. Assessment of left ventricular dysfunction among heart failure patients was also higher at RMC (98%) than the state (74%) or national (79%) average. For RMC pneumonia patients, 79% received antibiotics within 4 h of admission, which compared favorably with State (76%) and national (75%) average. RMC scored higher on 13 of 16 clinical process measures (p<0.01, sign test analysis, >95% CI) compared to state and national averages.
Although acute health care needs are often met with limited resources in medically underserved regions, RMC performed above state and national average for most process measures assessed in this review. Our data were derived from one facility and the associated findings may not be applicable in other healthcare settings. Further studies are planned to track other parameters and specific clinical outcomes at RMC, as well as to identify specific institutional policies that facilitate attainment of target quality measures.
调查田纳西州一家社区医院对特定紧急医疗需求的管理情况。
在这份描述性报告中，对田纳西州哈里曼市罗阿讷医疗中心（RMC）（人口6,757）的出院情况及相关标准流程指标进行了回顾性研究。从全国短期急性护理医院数据库中提取医院数据，以衡量截至2005年3月的14个月期间心肌梗死（MI）、心力衰竭和肺炎的16项质量绩效指标。这些数据还允许与州和全国参考组进行比较。
罗阿讷医疗中心心肌梗死（MI）患者中，94%在入院时接受了阿司匹林治疗，这一数字高于州平均水平（85%）和全国平均水平（91%）。罗阿讷医疗中心对心力衰竭患者左心室功能障碍的评估也高于州平均水平（74%）和全国平均水平（79%），为98%。对于罗阿讷医疗中心的肺炎患者，79%在入院后4小时内接受了抗生素治疗，与州平均水平（76%）和全国平均水平（75%）相比具有优势。与州和全国平均水平相比，罗阿讷医疗中心在16项临床流程指标中的13项上得分更高（p<0.01，符号检验分析，>95%置信区间）。
尽管在医疗服务不足的地区，急性医疗需求往往在资源有限的情况下得到满足，但罗阿讷医疗中心在本次审查评估的大多数流程指标上表现高于州和全国平均水平。我们的数据来自一个机构，相关发现可能不适用于其他医疗环境。计划进一步开展研究，以跟踪罗阿讷医疗中心的其他参数和特定临床结果，并确定有助于实现目标质量指标的具体机构政策。
