Simmons David, Cheung N Wah, McIntyre H David, Flack Jeff R, Lagstrom Janet, Bond Dianne, Johnson Elizabeth, Wolmarans Louise, Wein Peter, Sinha Ashim K
Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):198-206. doi: 10.1111/j.1479-828X.2007.00718.x.
Limited resources are available to compare outcomes of pregnancies complicated by diabetes across different centres.
To compare the use of paper, stand alone and networked electronic processes for a sustainable, systematic international audit of diabetes in pregnancy care.
Development of diabetes in pregnancy minimum dataset using nominal group technique, email user survey of difficulties with audit tools and collation of audit data from nine pilot sites across Australia and New Zealand.
Seventy-nine defined data items were collected: 33 were for all women, nine for those with gestational diabetes (GDM) and 37 for women with pregestational diabetes. After the pilot, four new fields were requested and 18 fields had queries regarding utility or definition. A range of obstacles hampered the implementation of the audit including Medical Records Committee processes, other medical/non-medical staff not initially involved, temporary staff, multiple clinical records used by different parts of the health service, difficulty obtaining the postnatal test results and time constraints. Implementation of electronic audits in both the networked and the stand-alone settings had additional problems relating to the need to nest within pre-existing systems. Among the 496 women (45 type 1; 43 type 2; 399 GDM) across the nine centres, there were substantial differences in key quality and outcome indicators between sites.
We conclude that an international, multicentre audit and benchmarking program is feasible and sustainable, but can be hampered by pre-existing processes, particularly in the initial introduction of electronic methods.
用于比较不同中心糖尿病合并妊娠结局的资源有限。
比较纸质、独立和联网电子流程在妊娠糖尿病护理可持续、系统的国际审计中的应用。
使用名义小组技术制定妊娠糖尿病最小数据集，通过电子邮件对审计工具的困难进行用户调查，并整理来自澳大利亚和新西兰九个试点地点的审计数据。
收集了79个定义的数据项：33个适用于所有女性，9个适用于妊娠期糖尿病（GDM）女性，37个适用于孕前糖尿病女性。试点后，又提出了4个新字段，18个字段存在关于效用或定义的疑问。一系列障碍阻碍了审计的实施，包括医疗记录委员会的流程、其他最初未参与的医疗/非医疗人员、临时工作人员、卫生服务不同部门使用的多个临床记录、难以获得产后检测结果以及时间限制。在联网和独立环境中实施电子审计还存在与需要嵌套在现有系统内相关的其他问题。在九个中心的496名女性（45名1型；43名2型；399名GDM）中，各地点之间的关键质量和结局指标存在很大差异。
我们得出结论，国际多中心审计和基准化计划是可行且可持续的，但可能会受到现有流程的阻碍，特别是在最初引入电子方法时。
