Habib Miriam R, Solomon Michael J, Young Jane M, Armstrong Bruce K, O'Connell Dianne, Armstrong Katie
Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia.
Dis Colon Rectum. 2009 Apr;52(4):616-22; discussion 622-3. doi: 10.1007/DCR.0b013e31819edb7d.
To describe a methodology for surgical audit and feedback based on hospital-level indicators of the quality of colorectal cancer care.
Process and outcome indicators were identified from a population-based database (N = 3095 patients treated by 258 surgeons at 130 hospitals across New South Wales between February 1, 2000 and January 31, 2001). Hospitals were ranked on each indicator, with those in the lowest 20th percentile receiving a score of 0 and the remainder receiving a score of 1. Scores for individual indicators were then summed for each hospital and divided by the number of relevant indicators to provide an evidence-based score (EBS) and a clinical outcome score.
Ten process and six clinical outcome indicators were identified. Hospital-level summary scores ranged from 0.14 to 1.0 for evidence-based processes and from 0.17 to 1.0 for clinical outcomes. Evidence-based score and clinical outcome score were independent (r = 0.12, P = 0.32). There was a small positive association between evidence-based score and caseload (r = 0.33, P = 0.005) but clinical outcome score and caseload were unrelated (r = 0.11, P = 0.36).
Evidence-based score and clinical outcome score address different aspects of quality of care. The wide variability of hospitals' outcome scores and an association of evidence-based score and caseload indicate that simple scores may be useful in audit and feedback.
描述一种基于结直肠癌护理质量的医院层面指标进行手术审计和反馈的方法。
从一个基于人群的数据库（2000年2月1日至2001年1月31日期间，新南威尔士州130家医院的258名外科医生治疗的3095例患者）中确定过程指标和结果指标。根据每个指标对医院进行排名，处于最低20%的医院得分为0，其余医院得分为1。然后将各医院的单个指标得分相加，再除以相关指标的数量，以得出基于证据的得分（EBS）和临床结果得分。
确定了10个过程指标和6个临床结果指标。基于证据的过程的医院层面汇总得分范围为0.14至1.0，临床结果的得分范围为0.17至1.0。基于证据的得分与临床结果得分相互独立（r = 0.12，P = 0.32）。基于证据的得分与病例量之间存在小的正相关（r = 0.33，P = 0.005），但临床结果得分与病例量无关（r = 0.11，P = 0.36）。
基于证据的得分和临床结果得分反映了护理质量的不同方面。医院结果得分的广泛变异性以及基于证据的得分与病例量的关联表明，简单得分可能在审计和反馈中有用。
