West Alan N, Weeks William B, Bagian James P
VA Outcomes Group REAP, VA Medical Center, White River Junction, VT 05009, USA.
Health Serv Res. 2008 Feb;43(1 Pt 1):249-66. doi: 10.1111/j.1475-6773.2007.00760.x.
To assess Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) as performance measures using Veterans Administration hospitalization data. DATA SOURCES STUDY SETTING: Nine years (1997-2005) of all Veterans Health Administration (VA) administrative hospital discharge data.
Retrospective analysis using diagnoses and procedures to derive annual rates and standard errors for 13 PSIs.
DATA COLLECTION/EXTRACTION METHODS: For either hospitals or hospital networks (Veterans Integrated Service Networks [VISNs]), we calculated the percentages whose PSI rates were consistently high or low across years, as well as 1-year lagged correlations, for each PSI. We related our findings to the average annual number of adverse events that each PSI represents. We also assessed time trends for the entire VA, by VISN, and by hospital.
PSI rates are more stable for VISNs than for individual hospitals, but only for those PSIs that reflect the most frequent adverse events. Only the most frequent PSIs yield significant time trends, and only for larger systems.
Because they are so rare, PSIs are not reliable performance measures to compare individual hospitals. The most frequent PSIs are more stable when applied to hospital networks, but needing large patient samples nullifies their potential value to managers seeking to improve quality locally or to patients seeking optimal care.
利用退伍军人管理局的住院数据，评估医疗保健研究与质量局的患者安全指标（PSIs）作为绩效衡量指标。数据来源研究背景：九年（1997 - 2005年）的所有退伍军人健康管理局（VA）行政医院出院数据。
采用回顾性分析，利用诊断和程序得出13项患者安全指标的年发生率和标准误差。
数据收集/提取方法：对于医院或医院网络（退伍军人综合服务网络[VISNs]），我们计算了各项患者安全指标在各年份中发生率持续偏高或偏低的百分比，以及滞后1年的相关性。我们将研究结果与每项患者安全指标所代表的平均每年不良事件数量联系起来。我们还评估了整个退伍军人管理局、按退伍军人综合服务网络以及按医院划分的时间趋势。
退伍军人综合服务网络的患者安全指标发生率比个别医院更稳定，但仅针对那些反映最常见不良事件的指标。只有最常见的患者安全指标呈现出显著的时间趋势，且仅适用于较大的系统。
由于患者安全指标极为罕见，因此它们并非用于比较个别医院的可靠绩效衡量指标。最常见的患者安全指标应用于医院网络时更稳定，但需要大量患者样本这一点削弱了它们对于寻求局部改善质量的管理人员或寻求最佳护理的患者的潜在价值。
