Pandey Dilip K, Cursio John F
Center for Stroke Research, Department of Neurology and Rehabilitation, University of Illinois at Chicago, 60612, USA.
Am J Prev Med. 2006 Dec;31(6 Suppl 2):S224-9. doi: 10.1016/j.amepre.2006.08.006. Epub 2006 Nov 7.
Feedback on "quality indicators" collected from chart audit is a widely used quality-improvement strategy. Skeptics argue that temporal change in practice patterns or improvement of documentation as a result of implementation of chart audit can affect change in quality indicators rather than change in practice due to feedback. This study compared the effectiveness in quality improvement for stroke care of chart audit and feedback versus chart audit only.
Data were examined on quality indicators constructed from the performance measures abstracted from chart audit for 1953 stroke patients admitted to 13 hospitals. Seven of the 13 hospitals were provided with feedback on quality indicators from baseline audit, and 6 hospitals had chart audit only.
Least-squares estimation was used to estimate the adjusted mean change in quality indicators between follow-up and baseline audits and differences in mean change between feedback and nonfeedback groups. Differences in adjusted mean change (with 90% confidence interval) were: deep vein thrombosis prophylaxis, 8.46 (-9.46 to 26.38); dysphagia screening, -3.78 (-21.37 to 13.81); antithrombotic therapy within 48 hours of hospitalization, 3.63 (-6.59 to 13.84); discharged on antithrombotic, -0.31 (-6.26 to 5.63); patients with atrial fibrillation discharged on warfarin/coumadin, 44.73 (-13.14 to 102.60); lipid screening, 19.93 (2.99 to 36.86); and smoking counseling, 17.47 (-12.13 to 47.08).
Although not statistically significant, results suggest a potential for improvement with data feedback. There is a need for evaluation of the effectiveness of a multifaceted approach in a community setting.
从病历审核中收集的“质量指标”反馈是一种广泛使用的质量改进策略。怀疑者认为，由于病历审核的实施，实践模式的时间变化或文档记录的改进可能会影响质量指标的变化，而不是由于反馈导致的实践变化。本研究比较了病历审核与反馈和仅病历审核对卒中护理质量改进的效果。
对从13家医院收治的1953例卒中患者的病历审核中提取的绩效指标构建的质量指标数据进行了检查。13家医院中有7家获得了基线审核的质量指标反馈，6家医院仅进行病历审核。
采用最小二乘法估计随访审核与基线审核之间质量指标的调整后平均变化，以及反馈组与无反馈组之间平均变化的差异。调整后平均变化（90%置信区间）的差异为：深静脉血栓形成预防，8.46（-9.46至26.38）；吞咽困难筛查，-3.78（-21.37至13.81）；住院48小时内的抗栓治疗，3.63（-6.59至13.84）；出院时接受抗栓治疗，-0.31（-6.26至5.63）；房颤患者出院时接受华法林/香豆素治疗，44.73（-13.14至102.60）；血脂筛查，19.93（2.99至36.86）；以及吸烟咨询，17.47（-12.13至47.08）。
虽然无统计学意义，但结果表明数据反馈有改进的潜力。需要在社区环境中评估多方面方法的有效性。
