From the Department of Maternal Fetal Medicine, Massachusetts General Hospital; and Director of Quality and Safety, Vincent Obstetrics and Gynecology, Massachusetts General Hospital.
Obstet Gynecol. 2010 Sep;116(3):728-732. doi: 10.1097/AOG.0b013e3181ea4d4f.
Quality measures allow providers, payers, and patients to assess and compare the performance of medical teams. The ideal quality measure is easy to define and observe, important to patients and physicians, and identifies areas ripe for improvement. There are several challenges unique to obstetrics that complicate quality measurement. Nationally available data are flawed and limited. Adverse outcomes are rare and difficult to compare between groups. An appropriate emphasis on teamwork makes assigning outcomes to individuals improper and impractical. We suggest some strategies that address these challenges and may improve obstetric measures: applying measures to teams rather than individuals, using sentinel events for internal root cause analysis rather than comparisons between groups, devising measures that account for alternatives, and developing data-collection fields that address important quality metrics directly. We highlight four measures that meet these criteria: 1) elective delivery before 39 weeks of gestation, 2) prophylactic antibiotic use for cesarean delivery, 3) the Adverse Outcome Index, and 4) the nulliparous term singleton vertex cesarean delivery rate. We suggest that each institution evaluate local priorities, select a measure, then continue to refine measures based on feedback from frontline clinicians.
质量指标可使医疗服务提供者、付款人和患者评估和比较医疗团队的表现。理想的质量指标应易于定义和观察，对患者和医生都很重要，并能确定有待改进的领域。妇产科有一些独特的挑战，使质量测量变得复杂。全国范围内的数据存在缺陷且有限。不良结果很少见，并且难以在组之间进行比较。适当强调团队合作使得将结果分配给个人是不恰当和不切实际的。我们提出了一些应对这些挑战并可能改进产科措施的策略：将措施应用于团队而不是个人，使用哨兵事件进行内部根本原因分析而不是组之间的比较，设计考虑替代方案的措施，并开发直接解决重要质量指标的数据收集字段。我们强调了四项符合这些标准的措施：1）39 孕周前的选择性分娩，2）剖宫产预防性使用抗生素，3）不良结局指数，4）初产妇足月单胎头剖宫产率。我们建议每个机构根据当地的优先事项评估，选择一个指标，然后根据一线临床医生的反馈继续改进指标。
