公开报告卡对改善心脏护理质量的有效性：EFFECT研究：一项随机试验

Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial.

作者信息

Tu Jack V, Donovan Linda R, Lee Douglas S, Wang Julie T, Austin Peter C, Alter David A, Ko Dennis T

机构信息

Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.

出版信息

JAMA. 2009 Dec 2;302(21):2330-7. doi: 10.1001/jama.2009.1731. Epub 2009 Nov 18.

DOI:10.1001/jama.2009.1731

PMID:19923205

Abstract

CONTEXT

Publicly released report cards on hospital performance are increasingly common, but whether they are an effective method for improving quality of care remains uncertain.

OBJECTIVE

To evaluate whether the public release of data on cardiac quality indicators effectively stimulates hospitals to undertake quality improvement activities that improve health care processes and patient outcomes.

DESIGN, SETTING, AND PATIENTS: Population-based cluster randomized trial (Enhanced Feedback for Effective Cardiac Treatment [EFFECT]) of 86 hospital corporations in Ontario, Canada, with patients admitted for acute myocardial infarction (AMI) or congestive heart failure (CHF).

INTERVENTION

Participating hospital corporations were randomized to early (January 2004) or delayed (September 2005) feedback of a public report card on their baseline performance (between April 1999 and March 2001) on a set of 12 process-of-care indicators for AMI and 6 for CHF. Follow-up performance data (between April 2004 and March 2005) also were collected.

MAIN OUTCOME MEASURES

The coprimary outcomes were composite AMI and CHF indicators based on 12 AMI and 6 CHF process-of-care indicators. Secondary outcomes were the individual process-of-care indicators, a hospital report card impact survey, and all-cause AMI and CHF mortality.

RESULTS

The publication of the early feedback hospital report card did not result in a significant systemwide improvement in the early feedback group in either the composite AMI process-of-care indicator (absolute change, 1.5%; 95% confidence interval [CI], -2.2% to 5.1%; P = .43) or the composite CHF process-of-care indicator (absolute change, 0.6%; 95% CI, -4.5% to 5.7%; P = .81). During the follow-up period, the mean 30-day AMI mortality rates were 2.5% lower (95% CI, 0.1% to 4.9%; P = .045) in the early feedback group compared with the delayed feedback group. The hospital mortality rates for CHF were not significantly different.

CONCLUSION

Public release of hospital-specific quality indicators did not significantly improve composite process-of-care indicators for AMI or CHF.

TRIAL REGISTRATION

http://clinicaltrials.gov Identifier: NCT00187460.

摘要

背景

公开发布的医院绩效报告卡越来越普遍，但它们是否是提高医疗质量的有效方法仍不确定。

目的

评估公开心脏质量指标数据是否能有效刺激医院开展改善医疗流程和患者预后的质量改进活动。

设计、地点和患者：对加拿大安大略省的86家医院集团进行基于人群的整群随机试验（有效心脏治疗强化反馈[EFFECT]），纳入因急性心肌梗死（AMI）或充血性心力衰竭（CHF）入院的患者。

干预措施

参与的医院集团被随机分为早期（2004年1月）或延迟（2005年9月）反馈组，反馈其在一组12项AMI护理流程指标和6项CHF护理流程指标上的基线表现（1999年4月至2001年3月）。还收集了随访期（2004年4月至2005年3月）的绩效数据。

主要结局指标

共同主要结局是基于12项AMI和6项CHF护理流程指标的综合AMI和CHF指标。次要结局是个体护理流程指标、医院报告卡影响调查以及全因AMI和CHF死亡率。

结果

早期反馈医院报告卡的发布并未使早期反馈组在综合AMI护理流程指标（绝对变化，1.5%；95%置信区间[CI]，-2.2%至5.1%；P = 0.43）或综合CHF护理流程指标（绝对变化，0.6%；95%CI，-4.5%至5.7%；P = 0.81）方面在全系统范围内有显著改善。在随访期内，早期反馈组的30天AMI平均死亡率比延迟反馈组低2.5%（95%CI，0.1%至4.9%；P = 0.045）。CHF的医院死亡率无显著差异。