Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Epidemiology, Western Sydney Local Health District, Sydney, New South Wales, Australia.
Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
PLoS One. 2014 Oct 13;9(10):e109807. doi: 10.1371/journal.pone.0109807. eCollection 2014.
Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002-2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.
尽管失败救治（Failure-to-Rescue，FTR）作为患者安全指标已被广泛接受（定义为可治疗并发症的手术患者中的死亡），但尚无研究探索大型卫生辖区内 FTR 的地理变化。我们的研究旨在探索澳大利亚新南威尔士州（NSW）的 FTR 发生率的时空变化。我们在澳大利亚 NSW 进行了一项基于人群的研究，使用了 2002 年至 2009 年期间所有在公立医院接受治疗的手术患者。我们使用贝叶斯框架下的集成嵌套 Laplace 逼近（INLA）方法开发了时空泊松模型，以获得特定区域的调整后相对风险。地方政府区域（LGA）被选为区域单位。LGA 聚集的协变量包括年龄、性别、社会经济和偏远程度指数评分、患者居住的邮政编码与治疗医院之间的距离以及二次时间趋势。我们研究了 NSW 8 年间 82 家急性公立医院的 4285494 例择期手术入院患者。在至少发生六种与 FTR 相关并发症之一的 14%的患者中（58590 人），在住院期间死亡。在 153 个 LGA 中，有 31 个 LGA 容纳了 NSW 风险患者的 48%，与州平均水平相比，这些 LGA 的调整后 FTR 风险过高（10%至 50%）。它们主要位于州的中心和悉尼西部。30 个 LGA 的调整后 FTR 风险较低（10%至 30%），容纳了 8%的风险患者，主要分布在 NSW 的南部和悉尼东部和南部。在八年期间，NSW 的 FTR 发生率存在显著的时空变化。确定的高风险和低风险 FTR 区域为决策者、临床医生和研究人员提供了潜在的机会，以了解为手术患者提供最佳护理的成功或失败，并建立一个自我学习的组织和卫生系统。
