Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA.
Ann Surg. 2011 Mar;253(3):611-8. doi: 10.1097/SLA.0b013e318208fd50.
We aimed to determine whether hospital-level surgical performance was similar across outpatient and inpatient settings.
The majority of surgical procedures in the United States are performed in an outpatient setting but most quality improvement focuses on inpatient care.
Using data from the 2006 to 2008 American College of Surgeons- National Surgical Quality Improvement Program, risk-adjusted hospital observed to expected ratios for morbidity and mortality were compared for inpatient and outpatient cases. In addition, hospital outpatient performance in each year was compared with performances in subsequent years.
Hospitals demonstrated variation in outcomes for outpatient morbidity with both good and poor outliers in each year. Outpatient mortality was so rare as to not support robust modeling. There was a lack of congruence between hospital performance for outpatient morbidity and either inpatient morbidity or inpatient mortality in each year, indicating that inpatient performance is not interchangeable with outpatient performance. Outpatient morbidity performance correlation between years was only moderate (correlations 0.449-0.534, all P < 0.001) indicating that although outcomes from 1 year mildly predict subsequent years, substitution of data would likely lead to missed opportunities for improvement.
Assessments of risk-adjusted hospital-level outpatient morbidity performance demonstrate (1) variability across American College of Surgeons- National Surgical Quality Improvement Program sites; (2) a lack of congruence between outpatient morbidity performance and either inpatient morbidity or mortality performance; (3) year-to-year variation of outpatient morbidity performance at individual institutions. Continuing evaluation of both outpatient and inpatient outcomes is supported. Given the substantial volume of outpatient care delivered, outpatient assessments are likely to be an important component of ongoing quality improvement efforts.
我们旨在确定医院层面的手术绩效是否在门诊和住院环境中具有相似性。
美国大多数外科手术是在门诊环境中进行的，但大多数质量改进工作都集中在住院护理上。
利用 2006 年至 2008 年美国外科医师学会-国家外科质量改进计划的数据，比较了住院和门诊病例的风险调整后医院观察到的发病率和死亡率与预期比率。此外，还比较了医院每年的门诊绩效与后续年份的绩效。
医院在门诊发病率方面的表现存在差异，每年都有良好和不良的异常值。门诊死亡率非常罕见，无法进行稳健建模。每年医院门诊发病率的表现与住院发病率或住院死亡率之间都缺乏一致性，表明住院表现不能替代门诊表现。每年门诊发病率之间的表现相关性仅为中度（相关性 0.449-0.534，均 P < 0.001），表明尽管 1 年的结果轻度预测后续年份，但替代数据可能会错失改进的机会。
对风险调整后医院层面门诊发病率绩效的评估表明：（1）美国外科医师学会-国家外科质量改进计划的各个站点之间存在差异；（2）门诊发病率表现与住院发病率或死亡率表现之间缺乏一致性；（3）个体机构门诊发病率的年度变化。继续评估门诊和住院结果是合理的。鉴于提供了大量的门诊护理，门诊评估可能是持续质量改进工作的重要组成部分。
