Soohoo Nelson F, Tang Edward Y, Krenek Lucie, Eagan Michael, McGlynn Elizabeth
Department of Orthopedic Surgery, University of California, Los Angeles, USA.
Orthopedics. 2011 May 18;34(5):356. doi: 10.3928/01477447-20110317-08.
While excellent clinical results have been seen with total knee replacement (TKR), extensive documentation exists in variations in outcomes due to factors such as hospital and surgeon volume. The hypothesis of this study was that statistically significant variation exists in the processes of care delivered to patients undergoing TKR at 3 affiliated hospitals.Retrospective chart review was used to compare the quality of care delivered to a sample of patients from an academic medical center, public county hospital, and private community hospital. Two hundred twenty-four patients undergoing primary TKR were included. Quality of care was measured by determining adherence to a set of 31 evidence-based quality indicators created using the RAND/UCLA modified Delphi expert panel methodology. The overall rate of adherence to the quality indicators was 53% (95% confidence interval [CI], 52%-55%) for the 224 patients. There was a statistically significant difference between sites, with patients treated at the high-volume academic center demonstrating a 58% rate of adherence (95% CI, 56%-61%) compared with 50% (95% CI, 48-51%; P =.008) at the lower-volume public hospital and 52% (95% CI, 51%-54%; P =.03) at the lower-volume private hospital.Further study is warranted to determine the extent of variation in the delivery of care and its relationship to variation in outcomes of care for patients undergoing TKR.
虽然全膝关节置换术（TKR）已取得了出色的临床效果，但由于医院规模和外科医生手术量等因素，关于手术结果差异的文献资料十分丰富。本研究的假设是，在3家附属医院接受TKR治疗的患者所接受的护理过程中存在具有统计学意义的差异。采用回顾性病历审查的方法，比较了来自一所学术医疗中心、一家公立县级医院和一家私立社区医院的患者样本所接受的护理质量。纳入了224例行初次TKR的患者。护理质量通过确定对一组使用RAND/UCLA改良德尔菲专家小组方法制定的31项循证质量指标的依从性来衡量。224例患者对质量指标的总体依从率为53%（95%置信区间[CI]，52%-55%）。各医院之间存在统计学显著差异，在手术量大的学术中心接受治疗的患者依从率为58%（95%CI，56%-61%），而在手术量小的公立医院为50%（95%CI，48%-51%；P=0.008），在手术量小的私立医院为52%（95%CI，51%-54%；P=0.03）。有必要进行进一步研究，以确定TKR患者护理提供方面差异的程度及其与护理结果差异的关系。
