Kuhn E M, Hartz A J, Gottlieb M S, Rimm A A
Division of Biostatistics/Clinical Epidemiology, Medical College of Wisconsin, Milwaukee 53226.
Med Care. 1991 Oct;29(10):1028-38. doi: 10.1097/00005650-199110000-00008.
To determine which characteristics of hospitals may be related to a higher quality of care, the association of hospital characteristics with the outcomes of medical record review by state Peer Review Organizations (PROs) was studied. The two data sources were: 1) the AHA 1986 Annual Survey of Hospitals and 2) reviews completed between July 1987 through June 1988 from six large PROs. For each hospital the percentage of cases that failed physician review (the confirmed problem rate) was computed. Hospital characteristics evaluated included financial status, ownership, medical training, technological sophistication, and size. The following characteristics were significantly associated with a lower confirmed problem rate: a higher occupancy rate, greater payroll expenses per bed, a higher proportion of physicians who were board-certified specialists, greater technological sophistication, a higher number of beds, a higher proportion of nurses who were registered, and membership in the Council of Teaching Hospitals. Public hospitals had higher problems rates than private not-for-profit hospitals. All characteristics significantly related to higher confirmed problem rates were also related to higher adjusted mortality rates in a previous study of 3,100 U.S. hospitals. The results suggest that hospital resources, including financial status, training of medical personnel, and availability of sophisticated equipment, are related to the quality of care provided by the hospital.
为了确定医院的哪些特征可能与更高的医疗质量相关，研究了医院特征与各州同行评审组织（PROs）病历评审结果之间的关联。两个数据源分别是：1）1986年美国医院协会年度调查；2）1987年7月至1988年6月期间六个大型PROs完成的评审。计算每家医院医师评审未通过病例的百分比（确认问题率）。评估的医院特征包括财务状况、所有权、医学培训、技术复杂性和规模。以下特征与较低的确认问题率显著相关：入住率较高、每张床位的工资支出较高、获得委员会认证的专科医生比例较高、技术复杂性较高、床位数量较多、注册护士比例较高以及教学医院理事会成员身份。公立医院的问题率高于私立非营利性医院。在之前对3100家美国医院的研究中，所有与较高确认问题率显著相关的特征也与较高的调整后死亡率相关。结果表明，医院资源，包括财务状况、医务人员培训和先进设备的可用性，与医院提供的医疗质量相关。
