Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
Clin Orthop Relat Res. 2012 Apr;470(4):1124-32. doi: 10.1007/s11999-011-2060-2.
The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.
QUESTIONS/PURPOSES: We identified existing evidence-based indicators of quality pediatric orthopaedic care and evaluated published QIs that may be applicable to pediatric orthopaedic care.
Using five standard search engines we searched the literature using terms such as "quality indicators," "orthopaedic surgery," and "pediatric." Study selection was performed in a stepwise manner, first by title, then abstract, and then full-text review. Of the 604 citations identified, 13 articles were selected for inclusion. Eight papers included only pediatric patients.
The most commonly reported indicator was mortality followed by postoperative complications. Reoperation and readmission rates were also reported along with patient-centered QIs, although with less frequency.
Although mortality and postoperative complications were the most frequently reported QIs, concern for their applicability was raised because of their relative infrequency in pediatrics. Patient-centered QIs appear to be the most useful tools reported, although their use is somewhat limited in the published literature. Although there are benefits and drawbacks to all reported QIs, patient-centered and surgeon-defined outcomes along with cost-effectiveness have important roles in evaluating the quality of pediatric orthopaedic care.
衡量医疗体系质量的能力已成为政府、私营部门和公众的首要任务。质量指标（QI）是指与结果相关的明确、可衡量的项目。使用 QI 可以启动当地的质量改进，并随着干预措施的实施，跟踪质量随时间的变化。
问题/目的：我们确定了现有的循证质量儿科骨科护理指标，并评估了可能适用于儿科骨科护理的已发表 QI。
我们使用五个标准搜索引擎，使用“质量指标”、“骨科手术”和“儿科”等术语搜索文献。研究选择是逐步进行的，首先是标题，然后是摘要，最后是全文审查。在确定的 604 条引文中，有 13 篇文章被选中纳入。其中 8 篇论文仅包括儿科患者。
报告最多的指标是死亡率，其次是术后并发症。还报告了再次手术和再次入院的比率以及以患者为中心的 QI，尽管报告的频率较低。
尽管死亡率和术后并发症是最常报告的 QI，但由于它们在儿科中的相对罕见性，对其适用性提出了关注。以患者为中心的 QI 似乎是报告中最有用的工具，但在已发表的文献中其使用有些受限。尽管所有报告的 QI 都有优点和缺点，但以患者为中心和外科医生定义的结果以及成本效益在评估儿科骨科护理质量方面具有重要作用。
