Raleigh Veena S, Cooper Jeremy, Bremner Stephen A, Scobie Sarah
Healthcare Commission, London EC1Y 8TG.
BMJ. 2008 Oct 17;337:a1702. doi: 10.1136/bmj.a1702.
To assess the feasibility of deriving patient safety indicators for England from routine hospital data and whether they can indicate adverse outcomes for patients.
Nine patient safety indicators developed by the United States Agency for Healthcare Research and Quality (AHRQ) were derived using hospital episode statistics for England for 2003-4, 2004-5, and 2005-6. A case-control analysis was undertaken to compare length of stay and mortality between cases (patients experiencing the particular safety event measured by an indicator) and controls matched for age, sex, health resource group (standard groupings of clinically similar treatments that use similar levels of healthcare resource), main specialty, and trust. Comparisons were undertaken with US data.
All NHS trusts in England.
Inpatients in NHS trusts.
There was fair consistency in national rates for the nine indicators across three years. For all but one indicator, hospital stays were longer in cases than in matched controls (range 0.2-17.1 days, P<0.001). Mortality in cases was also higher than in controls (5.7-27.1%, P<0.001), except for the obstetric trauma indicators. Excess length of stay and mortality in cases was greatest for postoperative hip fracture and sepsis. England's rates were lower than US rates for these indicators. Increased length of stay in cases was generally greater in England than in the US. Excess mortality was also higher in England than in the US, except for the obstetric trauma indicators where there were few deaths in both countries. Differences between England and the US in excess length of stay and mortality were most marked for postoperative hip fracture.
Hospital administrative data provide a potentially useful low burden, low cost source of information on safety events. Indicators can be derived with English data and show that cases have poorer outcomes than matched controls. These data therefore have potential for monitoring safety events. Further validation, for example, of individual cases, is needed and levels of event recording need to improve. Differences between England and the US might reflect differences in the depth of event coding and in health systems and patterns of healthcare provision.
评估从常规医院数据中得出适用于英格兰的患者安全指标的可行性，以及这些指标能否表明患者的不良结局。
利用2003 - 2004年、2004 - 2005年和2005 - 2006年英格兰的医院病历统计数据，得出美国医疗保健研究与质量局（AHRQ）制定的9项患者安全指标。进行病例对照分析，以比较病例组（经历由某项指标衡量的特定安全事件的患者）与在年龄、性别、卫生资源组（使用相似水平医疗资源的临床相似治疗的标准分组）、主要专科和信托机构方面相匹配的对照组之间的住院时间和死亡率。并与美国的数据进行了比较。
英格兰所有的国民保健服务信托机构。
国民保健服务信托机构中的住院患者。
这9项指标在三年中的全国发生率具有一定的一致性。除一项指标外，病例组的住院时间均长于匹配的对照组（范围为0.2 - 17.1天，P < 0.001）。病例组的死亡率也高于对照组（5.7 - 27.1%，P < 0.001），产科创伤指标除外。术后髋部骨折和败血症病例组的住院时间过长和死亡率过高的情况最为严重。这些指标在英格兰的发生率低于美国。病例组住院时间的增加在英格兰通常比在美国更为明显。除产科创伤指标在两国死亡病例都很少外，英格兰的超额死亡率也高于美国。术后髋部骨折在住院时间过长和死亡率方面，英格兰与美国的差异最为显著。
医院管理数据为安全事件提供了一个潜在有用的、负担轻且成本低的信息来源。可以用英国的数据得出指标，且表明病例组的结局比匹配的对照组更差。因此，这些数据具有监测安全事件的潜力。需要进一步验证，例如对个别病例的验证，并且事件记录水平需要提高。英格兰和美国之间的差异可能反映了事件编码深度以及卫生系统和医疗服务模式的差异。
