Mandell Samuel P, Robinson Ellen F, Cooper Claudette L, Klein Matthew B, Gibran Nicole S
Department of Surgery, UW Regional Burn Center, Harborview Medical Center, Seattle, Washington, USA.
J Burn Care Res. 2010 Jan-Feb;31(1):125-9. doi: 10.1097/BCR.0b013e3181cb8d00.
Recently, much attention has been placed on quality of care metrics and patient safety. Groups such as the University Health-System Consortium (UHC) collect and review patient safety data, monitor healthcare facilities, and often report data using mortality and complication rates as outcomes. The purpose of this study was to analyze the UHC database to determine if it differentiates quality of care across burn centers. We reviewed UHC clinical database (CDB) fields and available data from 2006 to 2008 for the burn product line. Based on the September 2008 American Burn Association (ABA) list of verified burn centers, we categorized centers as American Burn Association-verified burn centers, self-identified burn centers, and other centers that are not burn units but admit some burn patients. We compared total burn admissions, risk pool, complication rates, and mortality rates. Overall mortality was compared between the UHC and National Burn Repository. The UHC CDB provides fields for number of admissions, % intensive care unit admission, risk pool, length of stay, complication profiles, and mortality index. The overall numbers of burn patients in the database for the study period included 17,740 patients admitted to verified burn centers (mean 631 admissions/burn center/yr or per 2 years), 10,834 for self-identified burn centers (mean 437 admissions/burn center/yr or per 2 years), and 1,487 for other centers (mean 11.5 admissions/burn center/yr or per 2 years). Reported complication rates for verified burn centers (21.6%), self-identified burn centers (21.3%), and others (20%) were similar. Mortality rates were highest for self-identified burn centers (3.06%), less for verified centers (2.88%), and lowest for other centers (0.74%). However, these outcomes data may be misleading, because the risk pool criteria do not include burn-specific risk factors, and the inability to adjust for injury severity prevents rigorous comparison across centers. Databases such as the UHC CDB provide a potential to benchmark quality of care. However, reporting quality data for trauma and burns requires stringent understanding of injury data collection. Although quality measures are important for improving patient safety and establishing benchmarks for complication and mortality rates, caution must be taken when applying them to specific product lines.
最近，医疗质量指标和患者安全受到了广泛关注。大学卫生系统联盟（UHC）等组织收集并审查患者安全数据，监测医疗机构，并且经常使用死亡率和并发症发生率作为结果来报告数据。本研究的目的是分析UHC数据库，以确定其是否能区分各烧伤中心的医疗质量。我们回顾了UHC临床数据库（CDB）中2006年至2008年烧伤产品线的字段及可用数据。根据2008年9月美国烧伤协会（ABA）的认证烧伤中心名单，我们将中心分为美国烧伤协会认证的烧伤中心、自我认定的烧伤中心以及其他并非烧伤科室但收治部分烧伤患者的中心。我们比较了烧伤总入院人数、风险池、并发症发生率和死亡率。将UHC与国家烧伤数据库的总体死亡率进行了比较。UHC CDB提供了入院人数、重症监护病房入院百分比、风险池、住院时间、并发症概况和死亡率指数等字段。研究期间数据库中烧伤患者的总数包括：17740名患者入住认证烧伤中心（平均每个烧伤中心每年或每两年入院631例），10834名患者入住自我认定的烧伤中心（平均每个烧伤中心每年或每两年入院437例），1487名患者入住其他中心（平均每个烧伤中心每年或每两年入院11.5例）。认证烧伤中心报告的并发症发生率（21.6%）、自我认定的烧伤中心（21.3%）和其他中心（20%）相似。自我认定的烧伤中心死亡率最高（3.06%），认证中心较低（2.88%），其他中心最低（0.74%）。然而，这些结果数据可能会产生误导，因为风险池标准未包括烧伤特异性风险因素，且无法对损伤严重程度进行调整，从而妨碍了各中心之间的严格比较。像UHC CDB这样的数据库为衡量医疗质量提供了可能。然而，报告创伤和烧伤的质量数据需要对损伤数据收集有严格的理解。虽然质量指标对于提高患者安全和建立并发症及死亡率基准很重要，但在将其应用于特定产品线时必须谨慎。
