Kazandjian Vahé A, Wicker Karol G, Matthes Nikolas, Ogunbo Sam
Center for Performance Sciences, Elkridge, MD 21075, USA.
J Eval Clin Pract. 2008 Apr;14(2):354-9. doi: 10.1111/j.1365-2753.2008.00960.x.
Safer care is a strategic priority for health care organizations worldwide. Yet, the measurement and evaluation of key processes and outcomes associated with safer care remains challenging, even with existing performance measurement indicators. The multi-national Quality Indicator Project (QI Project) data are analysed to [1] document the patterns of safety indicators used between 1999 and 2006 among hospitals in Asia, Europe and the USA; and [2] to identify trends in using both organization-level and patient-level data in hospital performance improvement.
Retrospective data are used to ascertain how the use of safety indicators has changed in comparison to other QI Project indicators. 'Continent' rather than 'hospital' is used as the unit of analysis and P-values of the differences in use percentages across Asia, Europe and the USA are calculated.
There was a significant increase in the use of QI Project indicators in Asia between 1999 and 2006. Measured as the mean percentage of usage, the safety versus 'all other' indicators' increase in Asia was 43.7% versus 27% (P < 0.05) and 37.2% versus 24.4% (P < 0.05), respectively, during the study's time period. The European participants used both safety and all other indicators less frequently, 14.7% versus 18% (P < 0.05) and 9.5% versus 19.8% (P < 0.05), respectively. Finally, USA hospitals demonstrated a larger difference in the decrease of QI Project indicator use than European hospitals between the 'safety' and 'all other' indicators, 12.7% decrease for safety indicators and 7.1% for all others (P < 0.05). These findings are consistent with trends reported in a previous study.
Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient-level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominantly in the USA but anticipated to be adopted both in Europe and Asia.
安全护理是全球医疗机构的战略重点。然而，即便有现有的绩效衡量指标，对与安全护理相关的关键流程和结果进行衡量和评估仍具有挑战性。对多国质量指标项目（QI项目）数据进行分析，目的如下：[1]记录1999年至2006年间亚洲、欧洲和美国医院使用安全指标的模式；[2]确定在医院绩效改进中使用组织层面和患者层面数据的趋势。
使用回顾性数据来确定与其他QI项目指标相比，安全指标的使用情况有何变化。分析单位为“洲”而非“医院”，并计算亚洲、欧洲和美国使用百分比差异的P值。
1999年至2006年间，亚洲使用QI项目指标的情况显著增加。以平均使用百分比衡量，在研究期间，亚洲安全指标与“所有其他”指标的使用增加情况分别为43.7%对27%（P<0.05）和37.2%对24.4%（P<0.05）。欧洲参与者使用安全指标和所有其他指标的频率较低，分别为14.7%对18%（P<0.05）和9.5%对19.8%（P<0.05）。最后，美国医院在“安全”和“所有其他”指标之间，QI项目指标使用减少的差异比欧洲医院更大，安全指标减少12.7%，其他指标减少7.1%（P<0.05）。这些发现与之前一项研究报告的趋势一致。
传统绩效衡量方法继续帮助医院识别护理提供过程中安全的关键方面。基于之前一项研究的结果，亚洲、欧洲和美国的医院在追求整体绩效提升时，所使用的衡量方法类型出现了新趋势。特别是患者层面数据与组织层面指标的使用日益增加，这可能标志着衡量策略的连续性，目前主要在美国，但预计欧洲和亚洲也会采用。
