加利福尼亚州医院医生的患病率和护理质量的横断面分析。

Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.

J Hosp Med. 2010 Apr;5(4):200-7. doi: 10.1002/jhm.609.

BACKGROUND

Hospital leaders usually provide financial support to hospitalists groups, often with an expectation of improved performance on publicly reported quality metrics. Whether the presence of hospitalists is associated with differences in hospital-level performance is unknown.

OBJECTIVE

Assess the relationship between hospitalist prevalence and quality performance.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 208 California hospitals participating in a voluntary reporting initiative.

INTERVENTION

Survey of hospital personnel with knowledge of the utilization of hospitalists for patient care.

MEASUREMENTS

Sixteen publicly reported quality process measures across 3 medical conditions: acute myocardial infarction (AMI); congestive heart failure (CHF); and pneumonia. Using multivariable models, we assessed the relationship between the presence of hospitalists and the percentage of missed quality opportunities for each process measure.

RESULTS

Of 208 eligible hospitals, 170 (82%) had hospitalist services. After adjustment, hospitals with hospitalists had similar performance for cardiac and pneumonia measures assessed at admission and fewer missed processes for CHF measures assessed at discharge. Among sites with hospitalists, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P < 0.001) missed quality opportunities for AMI at admission, and 0.6% (P < 0.001), 0.5% (P = 0.004), and 1.5% (P = 0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.

CONCLUSIONS

The presence of hospitalists in California was associated with modest improvements in performance on publicly reported process measures. Whether hospitalists directly improve quality or simply reflect a hospital's level of investment in quality remains a subject for future study.

背景

医院领导通常为医院医师组提供财务支持，通常期望其在公开报告的质量指标上表现有所改善。然而，医院医师的存在是否与医院层面的绩效差异有关尚不清楚。

目的

评估医院医师的流行程度与质量绩效之间的关系。

设计

横断面研究。

参与者

参与自愿报告计划的加利福尼亚州 208 家医院。

干预措施

对了解医院医师在患者治疗中使用情况的医院人员进行调查。

测量指标

3 种医疗状况（急性心肌梗死（AMI）、充血性心力衰竭（CHF）和肺炎）的 16 项公开报告的质量流程指标。使用多变量模型，我们评估了医院医师的存在与每个流程指标的质量机会缺失百分比之间的关系。

结果

在 208 家符合条件的医院中，有 170 家（82%）提供了医院医师服务。调整后，有医院医师的医院在入院时的心脏和肺炎指标的表现相似，在出院时的 CHF 指标的质量机会缺失较少。在有医院医师的医院中，医院医师收治的患者比例每增加 10%，入院时 AMI 的质量机会缺失减少 0.5%（P < 0.001），出院时 AMI、CHF 和肺炎的质量机会缺失分别减少 0.6%（P < 0.001）、0.5%（P = 0.004）和 1.5%（P = 0.006）。