Department of Otolaryngology-Head and Neck Surgery, Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, PA.
Int Forum Allergy Rhinol. 2014 Apr;4(4):284-91. doi: 10.1002/alr.21284. Epub 2014 Jan 21.
The delivery of allergy immunotherapy in the otolaryngology office is variable and lacks standardization. Quality metrics encompasses the measurement of factors associated with good patient-centered care. These factors have yet to be defined in the delivery of allergy immunotherapy. We developed and applied quality metrics to 6 allergy practices affiliated with an academic otolaryngic allergy center.
This work was conducted at a tertiary academic center providing care to over 1500 patients. We evaluated methods and variability between 6 sites. Tracking of errors and anaphylaxis was initiated across all sites. A nationwide survey of academic and private allergists was used to collect data on current practice and use of quality metrics.
The most common types of errors recorded were patient identification errors (n = 4), followed by vial mixing errors (n = 3), and dosing errors (n = 2). There were 7 episodes of anaphylaxis of which 2 were secondary to dosing errors for a rate of 0.01% or 1 in every 10,000 injection visits/year. Site visits showed that 86% of key safety measures were followed. Analysis of nationwide survey responses revealed that quality metrics are still not well defined by either medical or otolaryngic allergy practices. Academic practices were statistically more likely to use quality metrics (p = 0.021) and perform systems reviews and audits in comparison to private practices (p = 0.005).
Quality metrics in allergy delivery can help improve safety and quality care. These metrics need to be further defined by otolaryngic allergists in the changing health care environment.
耳鼻喉科门诊提供过敏免疫治疗的方式存在差异，且缺乏标准化。质量指标涵盖了与以患者为中心的优质护理相关的因素的衡量。这些因素在过敏免疫治疗的实施中尚未得到明确界定。我们开发并应用了质量指标，对隶属于学术耳鼻喉过敏中心的 6 个过敏实践进行了评估。
这项工作是在一家提供超过 1500 名患者服务的三级学术中心进行的。我们评估了 6 个地点之间的方法和变异性。在所有地点都开始跟踪错误和过敏反应。我们使用一项针对学术和私人过敏症医生的全国性调查来收集有关当前实践和质量指标使用的数据。
记录的最常见错误类型是患者身份识别错误（n = 4），其次是小瓶混合错误（n = 3）和剂量错误（n = 2）。发生了 7 次过敏反应，其中 2 次是由于剂量错误引起的，发生率为 0.01%，即每 10,000 次注射就诊/年 1 次。现场访问显示，86%的关键安全措施得到了遵循。对全国性调查答复的分析表明，医疗或耳鼻喉过敏症实践都尚未很好地定义质量指标。与私人实践相比，学术实践更有可能使用质量指标（p = 0.021），并进行系统审查和审计（p = 0.005）。
过敏免疫治疗中的质量指标有助于提高安全性和护理质量。在不断变化的医疗保健环境中，耳鼻喉过敏症医生需要进一步定义这些指标。
