教学型与非教学型创伤中心所采用的质量改进措施：对美国、加拿大、澳大利亚和新西兰成人创伤中心的一项跨国调查分析

Quality improvement practices used by teaching versus non-teaching trauma centres: analysis of a multinational survey of adult trauma centres in the United States, Canada, Australia, and New Zealand.

作者信息

Chaubey Vikas P, Roberts Derek J, Ferri Mauricio B, Bobrovitz Niklas H, Stelfox Henry T

机构信息

Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB T2N 2T9, Canada.

出版信息

BMC Surg. 2014 Dec 22;14:112. doi: 10.1186/1471-2482-14-112.

DOI:10.1186/1471-2482-14-112

PMID:25533153

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4320430/

Abstract

BACKGROUND

Although studies have suggested that a relationship exists between hospital teaching status and quality improvement activities, it is unknown whether this relationship exists for trauma centres.

METHODS

We surveyed 249 adult trauma centres in the United States, Canada, Australia, and New Zealand (76% response rate) regarding their quality improvement programs. Trauma centres were stratified into two groups (teaching [academic-based or -affiliated] versus non-teaching) and their quality improvement programs were compared.

RESULTS

All participating trauma centres reported using a trauma registry and measuring quality of care. Teaching centres were more likely than non-teaching centres to use indicators whose content evaluated treatment (18% vs. 14%, p < 0.001) as well as the Institute of Medicine aim of timeliness of care (23% vs. 20%, p < 0.001). Non-teaching centres were more likely to use indicators whose content evaluated triage and patient flow (15% vs. 18%, p < 0.001) as well as the Institute of Medicine aim of efficiency of care (25% vs. 30%, p < 0.001). While over 80% of teaching centres used time to laparotomy, pulmonary complications, in hospital mortality, and appropriate admission physician/service as quality indicators, only two of these (in hospital mortality and appropriate admission physician/service) were used by over half of non-teaching trauma centres. The majority of centres reported using morbidity and mortality conferences (96% vs. 97%, p = 0.61) and quality of care audits (94% vs. 88%, p = 0.08) while approximately half used report cards (51% vs. 43%, p = 0.22).

CONCLUSIONS

Teaching and non-teaching centres reported being engaged in quality improvement and exhibited largely similar quality improvement activities. However, differences exist in the type and frequency of quality indicators utilized among teaching versus non-teaching trauma centres.

摘要

背景

尽管研究表明医院教学状况与质量改进活动之间存在关联，但尚不清楚这种关系在创伤中心是否存在。

方法

我们对美国、加拿大、澳大利亚和新西兰的249家成人创伤中心（回复率为76%）进行了关于其质量改进项目的调查。创伤中心被分为两组（教学型[基于学术或附属学术机构]与非教学型），并对它们的质量改进项目进行比较。

结果

所有参与调查的创伤中心均报告使用创伤登记系统并衡量医疗质量。教学中心比非教学中心更有可能使用内容涉及评估治疗的指标（18%对14%，p<0.001）以及医学研究所提出的医疗及时性目标（23%对20%，p<0.001）。非教学中心更有可能使用内容涉及评估分诊和患者流程的指标（15%对18%，p<0.001）以及医学研究所提出的医疗效率目标（25%对30%，p<0.001）。虽然超过80%的教学中心将剖腹手术时间、肺部并发症、住院死亡率以及合适的入院医生/服务作为质量指标，但这些指标中只有两项（住院死亡率和合适的入院医生/服务）被超过一半的非教学创伤中心使用。大多数中心报告使用发病率和死亡率会议（96%对97%，p = 0.61）以及医疗质量审核（94%对88%，p = 0.08），而约一半的中心使用报告卡（51%对43%，p = 0.22）。