Martinez Elizabeth A, Donelan Karen, Henneman Justin P, Berenholtz Sean M, Miralles Paola D, Krug Allison E, Iezzoni Lisa I, Charnin Jonathan E, Pronovost Peter J
1Massachusetts General Hospital, Boston, MA.
Am J Med Qual. 2014 Mar-Apr;29(2):144-52. doi: 10.1177/1062860613491823. Epub 2013 Jul 25.
Despite important progress in measuring the safety of health care delivery in a variety of health care settings, a comprehensive set of metrics for benchmarking is still lacking, especially for patient outcomes. Even in high-risk settings where similar procedures are performed daily, such as hospital intensive care units (ICUs), these measures largely do not exist. Yet we cannot compare safety or quality across institutions or regions, nor can we track whether safety is improving over time. To a large extent, ICU outcome measures deemed valid, important, and preventable by clinicians are unavailable, and abstracting clinical data from the medical record is excessively burdensome. Even if a set of outcomes garnered consensus, ensuring adequate risk adjustment to facilitate fair comparisons across institutions presents another challenge. This study reports on a consensus process to build 5 outcome measures for broad use to evaluate the quality of ICU care and inform quality improvement efforts.
尽管在衡量各种医疗环境中医疗服务提供的安全性方面取得了重要进展，但仍然缺乏一套全面的用于基准测试的指标，尤其是针对患者预后的指标。即使在每天进行类似手术的高风险环境中，如医院重症监护病房（ICU），这些指标也大多不存在。然而，我们无法在不同机构或地区之间比较安全性或质量，也无法追踪安全性是否随时间推移而改善。在很大程度上，临床医生认为有效的、重要的且可预防的ICU预后指标无法获得，从病历中提取临床数据负担过重。即使一组预后指标获得了共识，确保进行充分的风险调整以促进不同机构之间的公平比较也是另一个挑战。本研究报告了一个达成共识的过程，以构建5个广泛使用的预后指标，用于评估ICU护理质量并为质量改进工作提供信息。
