Perla Rocco J, Hohmann Samuel F, Annis Karen
Division of Quantitative Health Sciences at the University of Massachusetts Medical School, USA.
J Healthc Qual. 2013 Sep-Oct;35(5):20-31. doi: 10.1111/jhq.12027.
Hospitals often have limited ability to obtain primary clinical data from electronic health records to use in assessing quality and safety. We outline a new model that uses administrative data to gauge the safety of care at the hospital level. The model is based on a set of highly undesirable events (HUEs) defined using administrative data and can be customized to address the priorities and needs of different users. Patients with HUEs were identified using discharge abstracts from July 1, 2008 through June 30, 2010. Diagnoses were classified as HUEs based on the associated present-on-admission status. The 2-year study population comprised more than 6.5 million discharges from 161 hospitals. The proportion of hospitalizations including at least one HUE during the 24-month study period varied greatly among hospitals, with a mean of 7.74% (SD 2.3%) and a range of 13.32% (max, 15.31%; min, 1.99%). The whole-patient measure of safety provides a global measure to use in assessing hospitals with the patient's entire care experience in mind. As administrative and clinical datasets become more consistent, it becomes possible to use administrative data to compare the rates of HUEs across organizations and to identify opportunities for improvement.
医院通常在从电子健康记录中获取用于评估质量和安全的主要临床数据方面能力有限。我们概述了一种新模型，该模型使用行政数据来衡量医院层面的医疗安全。该模型基于一组使用行政数据定义的极不良事件（HUEs），并且可以进行定制以满足不同用户的优先事项和需求。使用2008年7月1日至2010年6月30日的出院摘要来识别患有HUEs的患者。根据入院时的相关状况，将诊断分类为HUEs。为期两年的研究人群包括来自161家医院的650多万例出院病例。在24个月的研究期间，至少包含一项HUE的住院比例在各医院之间差异很大，平均为7.74%（标准差2.3%），范围为13.32%（最大值为15.31%；最小值为1.99%）。全患者安全指标提供了一种综合指标，用于在考虑患者整体护理体验的情况下评估医院。随着行政和临床数据集变得更加一致，利用行政数据来比较不同组织之间的HUEs发生率并识别改进机会成为可能。
