Danish Institute for Quality and Accreditation in Healthcare, DK-8200 Aarhus N, Denmark.
BMC Health Serv Res. 2009 Oct 12;9:186. doi: 10.1186/1472-6963-9-186.
We examined the association between quality of care and 30 day mortality in a nationwide cohort of patients hospitalized with hip fracture.
We used data from The Danish National Indicator Project, a quality improvement initiative with participation of more than 90% of Danish hospital departments caring for patients with hip fracture between August 16, 2005 and August 15, 2006. Quality of care was measured in terms of meeting five specific criteria: early assessment of the patient's nutritional risk, systematic pain assessment during mobilization, assessment of Activities of Daily Living (ADL) before the fracture, assessment of ADL before discharge, and initiation of treatment to prevent future osteoporotic fractures. The association between meeting each of the quality of care criteria for the patient and 30 day mortality was examined using logistic regression to adjust for potential confounders.
6,266 patients hospitalized with an incident episode of hip fracture were included in the study. For four of the five quality of care criteria, patients who met the criterion had substantially lower 30 day mortality after hip fracture. The adjusted mortality odds ratios (ORs) ranged from 0.42 (95% CI, 0.30 to 0.58) for assessment of ADL before discharge (excluding deaths during hospitalization) to 0.72 (95% CI, 0.52 to 1.00) for systematic pain assessment. We found an inverse dose-response relationship between the number of quality of care criteria met and 30 day mortality; the lowest mortality was found among patients for whom all five quality of care criteria were met, as compared with patients for whom no quality of care criteria were met: adjusted mortality OR 0.18 (95% CI, 0.09 to 0.36).
Higher quality of care during hospitalization with hip fracture was associated with lowered 30 day mortality.
我们研究了在全国范围内髋部骨折住院患者队列中，医疗质量与 30 天死亡率之间的关系。
我们使用了丹麦国家指标项目的数据，这是一项质量改进计划，参与了 2005 年 8 月 16 日至 2006 年 8 月 15 日期间丹麦 90%以上的髋部骨折患者治疗科室。医疗质量是通过满足五个特定标准来衡量的：对患者营养风险的早期评估、在活动时进行系统的疼痛评估、骨折前评估日常生活活动（ADL）、出院前评估 ADL 以及开始治疗以预防未来的骨质疏松性骨折。使用逻辑回归来调整潜在的混杂因素，研究了满足每位患者的医疗质量标准与 30 天死亡率之间的关联。
本研究共纳入了 6266 名因髋部骨折住院的患者。对于五个质量标准中的四个，满足标准的患者在髋部骨折后 30 天死亡率明显较低。调整后的死亡率比值比（OR）范围从出院前评估 ADL（不包括住院期间死亡）的 0.42（95%可信区间，0.30 至 0.58）到系统疼痛评估的 0.72（95%可信区间，0.52 至 1.00）。我们发现，满足的质量标准数量与 30 天死亡率之间呈反比剂量反应关系；与未满足任何质量标准的患者相比，满足所有五个质量标准的患者的死亡率最低：调整后的死亡率 OR 0.18（95%可信区间，0.09 至 0.36）。
髋部骨折住院期间的医疗质量越高，30 天死亡率越低。
