Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte, Charité-University Medicine Berlin, Berlin, Germany.
PLoS One. 2013 Jun 12;8(6):e65428. doi: 10.1371/journal.pone.0065428. Print 2013.
Outcome assessment is the standard for evaluating the quality of health services worldwide. In this study, outcome has been divided into immediate and final outcome. Aim was to compare an intervention hospital with a Continuous Quality Improvement approach to a control group using benchmark assessments of immediate outcome indicators in surgical care. Results were compared to final outcome indicators.
Surgical care quality in six hospitals in Tanzania was assessed from 2006-2011, using the Hospital Performance Assessment Tool. Independent observers assessed structural, process and outcome quality using checklists based on evidence-based guidelines. The number of surgical key procedures over the benchmark of 80% was compared between the intervention hospital and the control group. Results were compared to Case Fatality Rates.
In the intervention hospital, in 2006, two of nine key procedures reached the benchmark, one in 2009, and four in 2011. In the control group, one of nine key procedures reached the benchmark in 2006, one in 2009, and none in 2011. Case Fatality Rate for all in-patients in the intervention hospital was 5.5% (n = 12,530) in 2006, 3.5% (n = 21,114) in 2009 and 4.6% (n = 18,840) in 2011. In the control group it was 3.1% (n = 17,827) in 2006, 4.2% (n = 13,632) in 2009 and 3.8% (n = 17,059) in 2011.
Results demonstrated that quality assurance improved performance levels in both groups. After the introduction of Continuous Quality Improvement, performance levels improved further in the intervention hospital while quality in the district hospital did not. Immediate outcome indicators appeared to be a better steering tool for quality improvement compared to final outcome indicators. Immediate outcome indicators revealed a need for improvement in pre- and postoperative care.
Quality assurance programs based on immediate outcome indicators can be effective if embedded in Continuous Quality Improvement. Nevertheless, final outcome indicators cannot be neglected.
结果评估是评估全球卫生服务质量的标准。本研究将结果分为即时结果和最终结果。目的是通过对手术护理即时结果指标的基准评估，比较采用持续质量改进方法的干预医院与对照组。将结果与最终结果指标进行比较。
2006 年至 2011 年，使用医院绩效评估工具评估坦桑尼亚六家医院的外科护理质量。独立观察员使用基于循证指南的检查表评估结构、过程和结果质量。干预医院和对照组之间比较了 80%基准以上的外科关键手术数量。将结果与病死率进行比较。
在干预医院，2006 年有 9 项关键手术中的两项达到基准，2009 年有一项，2011 年有四项。对照组 2006 年有一项关键手术达到基准，2009 年有一项，2011 年没有。干预医院所有住院患者的病死率在 2006 年为 5.5%（n=12530），2009 年为 3.5%（n=21114），2011 年为 4.6%（n=18840）。对照组 2006 年为 3.1%（n=17827），2009 年为 4.2%（n=13632），2011 年为 3.8%（n=17059）。
结果表明，质量保证提高了两组的绩效水平。在引入持续质量改进后，干预医院的绩效水平进一步提高，而区医院的质量没有提高。与最终结果指标相比，即时结果指标似乎是质量改进的更好指导工具。即时结果指标显示，术前和术后护理需要改进。
如果基于即时结果指标的质量保证计划嵌入持续质量改进中，可能会有效。然而，最终结果指标不容忽视。
