临床治理是否会影响住院时间的合理性？

Does clinical governance influence the appropriateness of hospital stay?

作者信息

Specchia Maria Lucia, Poscia Andrea, Volpe Massimo, Parente Paolo, Capizzi Silvio, Cambieri Andrea, Damiani Gianfranco, Ricciardi Walter, De Belvis Antonio Giulio

机构信息

Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy.

Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy.

出版信息

BMC Health Serv Res. 2015 Apr 3;15:142. doi: 10.1186/s12913-015-0795-2.

DOI:10.1186/s12913-015-0795-2

PMID:25889675

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4392497/

Abstract

BACKGROUND

Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay.

METHODS

A cross-sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV(©) (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. Organizational appropriateness was measured retrospectively using the Italian version of the Appropriateness Evaluation Protocol to analyze a random sample of medical records for each clinical unit. Pearson-correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels.

RESULTS

47 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with almost all the main Clinical Governance dimensions. Adjusted multiple regression analysis resulted in a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β = -0.28; p < 0.001; R-squared = 0.8). EBM and Clinical Audit represented the Clinical Governance dimensions which had the strongest association with organizational appropriateness.

CONCLUSIONS

This study suggests that the evaluation of both Clinical Governance and organizational appropriateness through standardized and repeatable tools, such as OPTIGOV(©) and AEP, is a key strategy for healthcare quality. The relationship between the two underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rational improvement of appropriateness levels.

摘要

背景

临床治理通过一个连贯统一的项目提供了一个评估和改善临床质量的框架。组织适宜性旨在实现最佳的健康结果和资源的最合理利用。本研究的目的是验证临床治理与住院适宜性之间可能存在的关系。

方法

2012年在一家意大利教学医院进行了一项横断面研究。采用OPTIGOV(©)（优化医疗保健治理）方法来量化临床治理在整体及其主要维度上的实施水平。使用意大利版的适宜性评估协议对每个临床科室的病历随机样本进行回顾性分析，以衡量组织适宜性。采用Pearson相关性分析和多元线性回归分析来检验住院不适宜天数百分比与临床治理实施水平之间的关系。