Hannan E L, Kilburn H, O'Donnell J F, Lukacik G, Shields E P
Office of Health Systems Management, State of New York Department of Health 12237.
JAMA. 1990 Dec 5;264(21):2768-74.
This study analyzes data from New York State's new Cardiac Surgery Reporting System, which contains information about cardiac preoperative risk factors, postoperative complications, and hospital discharge. The purposes of the study were to determine the set of significant clinical risk factors and to identify cardiac surgical centers most likely to have serious quality-of-care problems. Significant risk factors for in-hospital death were age, gender, ejection fraction, previous myocardial infarction, number of open heart operations in previous admissions, diabetes requiring medication, dialysis dependence, disasters (acute structural defect, renal failure, cardiogenic shock, gunshot), unstable angina, intractable congestive heart failure, left main trunk narrowed more than 90%, and type of operation performed. Four of the 28 hospitals had significantly higher mortality rates than expected, given the risk factors of their patients. Subsequent site visits and medical record reviews confirmed that these facilities had high percentages of quality-of-care problems among cases resulting in mortality.
本研究分析了纽约州新的心脏手术报告系统中的数据，该系统包含心脏术前危险因素、术后并发症及出院情况等信息。本研究的目的是确定一组重要的临床危险因素，并找出最有可能存在严重护理质量问题的心脏外科中心。住院死亡的重要危险因素包括年龄、性别、射血分数、既往心肌梗死、既往住院期间心脏直视手术次数、需药物治疗的糖尿病、透析依赖、灾难情况（急性结构缺陷、肾衰竭、心源性休克、枪伤）、不稳定型心绞痛、难治性充血性心力衰竭、左主干狭窄超过90%以及所施行的手术类型。鉴于患者的危险因素，28家医院中有4家的死亡率显著高于预期。随后的实地考察和病历审查证实，在导致死亡的病例中，这些机构存在护理质量问题的比例很高。
