社区获得性肺炎的护理流程和结果。
Processes of care and outcomes for community-acquired pneumonia.
机构信息
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, USA.
出版信息
Am J Med. 2011 Dec;124(12):1175.e9-17. doi: 10.1016/j.amjmed.2011.05.029. Epub 2011 Oct 13.
BACKGROUND
Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain.
METHODS
For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [<4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed.
RESULTS
Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P≥.13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed (P=.39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models.
CONCLUSION
Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.
背景
尽管护理流程是医疗质量的常见替代指标，但它们与医疗结果的关系仍不确定。
方法
在对来自 32 个急诊室的 2076 名肺炎住院患者进行研究中，我们使用多水平逻辑回归模型评估了患者结局与 4 项护理流程（氧合评估、血培养、快速起始[＜4 小时]和抗生素治疗的适当选择）以及护理流程执行总数之间的独立关联。
结果
总体而言，有 141 名患者（6.8%）死亡。与执行了单个护理流程的患者相比，每个流程的死亡率降低了 0.3%至 1.7%（每项比较的 P≥.13）；接受了 0 至 2 项护理流程的患者死亡率为 7.5%，接受了 3 项护理流程的患者死亡率为 7.2%，接受了所有 4 项护理流程的患者死亡率为 5.8%（P=.39）。在多变量模型中，单个或累计护理流程指标与短期死亡率均无显著关联。
结论
肺炎患者的短期死亡率与单个护理流程或执行的累计数量均无关联。
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