Bitzer Eva Maria, Nickel Stefan, Lorenz Christoph, Trojan Alf, Dörning Hans
ISEG - Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung, Hannover.
Z Arztl Fortbild Qualitatssich. 2006;100(3):189-95.
Based on patient-reported process and outcome indicators of care, a system for quality improvement in short-stay surgery was developed for hernia repair and cholecystectomy. The study aimed to test the feasibility and validity of the system.
In two centres for short-stay surgery all patients referred for hernia repair or cholecystectomy were surveyed between August 1999 and January 2002 (T0: preoperative, T1: 14 days post-OP, T2: 6 months post-OP). At T0 and T1 survey instruments were given to patients in the participating centres, at T2 the survey instruments were mailed. Of 342 hernia patients and 250 cholecystolithiasis patients at T0, responses from only 54.1% (hernia) and 63.4% (cholecystolithiasis) were available at T2. Non-response predominantly occurred between T0 and T1. Patients reported on satisfaction with care (FKKP), health-related quality of life (HRQL; SF-36), disease-specific symptoms (symptom checklists), treatment satisfaction and other indicators.
Satisfaction with care was quite high. The process indicator of the lowest satisfaction was the provision of competencies to deal with problems at home after discharge at home. At T2 21.1% (hernia) and 66.2% (cholecystolithiasis) reported no complications. Both symptom checklists reflect the positive postoperative course (effect size T0-T2: 1.16 and 0.75). From a T0 level lower than the German reference population (six of the eight SF-36 subscales) HRQL reaches or exceeds the population norms at T2.
In general, both the proposed proceedings and the instrument were applicable and feasible. Patient-oriented quality indicators contain additional information on processes and outcomes of care. However, the participating centres were not fully prepared to spend the extra effort necessary to organise such a longitudinal survey. To decrease non-response between T0 and T1, survey instruments should be mailed at T1 (instead of handing them over to patients during their postoperative visit).
基于患者报告的护理过程和结果指标，开发了一种用于短期手术质量改进的系统，用于疝气修补术和胆囊切除术。本研究旨在测试该系统的可行性和有效性。
在两个短期手术中心，于1999年8月至2002年1月期间对所有转诊进行疝气修补术或胆囊切除术的患者进行了调查（T0：术前，T1：术后14天，T2：术后6个月）。在T0和T1时，将调查问卷分发给参与中心的患者，在T2时，通过邮寄方式发放调查问卷。在T0时，有342名疝气患者和250名胆囊结石患者，在T2时，仅获得了54.1%（疝气）和63.4%（胆囊结石）的回复。无回复主要发生在T0和T1之间。患者报告了对护理的满意度（FKKP）、健康相关生活质量（HRQL；SF - 36）、疾病特异性症状（症状清单）、治疗满意度及其他指标。
对护理的满意度相当高。满意度最低的过程指标是出院后在家中处理问题的能力提供情况。在T2时，21.1%（疝气）和66.2%（胆囊结石）报告无并发症。两份症状清单均反映了术后的良好进程（效应量T0 - T2：1.16和0.75）。从低于德国参考人群的T0水平（SF - 36的八个子量表中的六个）开始，HRQL在T2时达到或超过人群规范。
总体而言，所提议的程序和工具都是适用且可行的。以患者为导向的质量指标包含了关于护理过程和结果的额外信息。然而，参与中心并未完全准备好花费额外的精力来组织这样一项纵向调查。为了减少T0和T1之间的无回复情况，调查问卷应在T1时邮寄（而不是在患者术后复诊时交给他们）。
