Centre of Research Excellence in Patient Safety, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2009 Jun;39(6):352-60. doi: 10.1111/j.1445-5994.2009.01961.x. Epub 2009 Mar 23.
Development of indicators to measure health-care quality has progressed rapidly. This development has, however, rarely occurred in a systematic fashion, and some aspects of care have received more attention than others. The aim of this study is to identify and classify indicators currently in use to measure the quality of care provided by hospitals, and to identify gaps in current measurement.
A literature search was undertaken to identify indicator sets. Indicators were included if they related to hospital care and were clearly being collected and reported to an external body. A two-person independent review was undertaken to classify indicators according to aspects of care provision (structure, process or outcome), dimensions of quality (safety, effectiveness, efficiency, timeliness, patient-centredness and equity), and domain of application (hospital-wide, surgical and non-surgical clinical specialities).
383 discrete indicators were identified from 22 source organizations or projects. Of these, 27.2% were relevant hospital-wide, 26.1% to surgical patients and 46.7% to non-surgical specialities, departments or diseases. Cardiothoracic surgery, cardiology and mental health were the specialities with greatest coverage, while nine clinical specialities had fewer than three specific indicators. Processes of care were measured by 54.0% of indicators and outcomes by 38.9%. Safety and effectiveness were the domains most frequently represented, with relatively few indicators measuring the other dimensions.
Despite the large number of available indicators, significant gaps in measurement still exist. Development of indicators to address these gaps should be a priority. Work is also required to evaluate whether existing indicators measure what they purport to measure.
衡量医疗质量的指标发展迅速。然而，这种发展很少是系统的，一些方面的护理比其他方面受到更多的关注。本研究的目的是确定和分类目前用于衡量医院提供的护理质量的指标，并确定当前测量中的差距。
进行文献检索以确定指标集。如果指标与医院护理有关，并且明确正在收集并向外部机构报告，则将其纳入。由两名独立人员进行审查，根据护理提供的方面（结构、过程或结果）、质量维度（安全性、有效性、效率、及时性、以患者为中心和公平性）以及应用领域（全院、外科和非外科临床专业）对指标进行分类。
从 22 个来源组织或项目中确定了 383 个离散指标。其中，27.2%与全院相关，26.1%与外科患者相关，46.7%与非外科专业、科室或疾病相关。心胸外科、心脏病学和心理健康是覆盖范围最大的专业，而有九个临床专业的具体指标少于三个。有 54.0%的指标衡量护理过程，38.9%的指标衡量护理结果。安全性和有效性是最常代表的领域，很少有指标衡量其他维度。
尽管有大量可用的指标，但在测量方面仍然存在很大的差距。开发用于解决这些差距的指标应是优先事项。还需要评估现有的指标是否衡量其声称要衡量的内容。
