Moini Majid, Rezaishiraz Hamed, Zarineh Alireza, Rasouli Mohammad R
Department of Surgery, Sina Hospital Medical Sciences/Tehran University, Hassan-abad Square, 1136933511, Tehran, Iran.
Department of Surgery, Sina Hospital, Medical Sciences/Tehran University, Tehran, Iran.
Eur J Trauma Emerg Surg. 2009 Feb;35(1):56-60. doi: 10.1007/s00068-008-7044-x. Epub 2008 Mar 18.
Evaluating processes of care and outcomes of injured patients are important if improvements in the quality of care delivered to injured patients are to be accomplished. We applied a customized ASCOT model developed from our database as a tool to criticize the quality of care in a local hospital.
A total number of 4,096 trauma patients were used to develop new coefficients for customization of ASCOT. These patients were divided randomly into two equal groups. New coefficients for ASCOT were derived from the first set of patients. The newly developed model was validated in the second group of patients and the measures of discrimination (area under the ROC curve) and calibration (Hosmer-Lemeshow goodness of fit) were calculated. Then we used the customized model to calculate the W score in different subgroups of patients treated in a local hospital to evaluate the care offered to patients in each group.
The customized ASCOT had a good discrimination (area under ROC curve = 0.9575) and calibration (Hosmer-Lemeshow goodness of fit p value = 0.7628) in the validation dataset. Using the customized model, we calculated W score in different subgroup of patients treated in a local hospital for a period of six months. The quality of care was worst for laparotomy (W = -13.31) and pelvic fracture (W = -5.56) and best for orthopedic (W = 1.76) operations.
We believe that a customization of ASCOT model when used for evaluation of quality of care in a local hospital can be useful for detection of defects and improvement of the process of care delivered to the patients.
若要实现提高为受伤患者提供的护理质量这一目标，评估护理流程及受伤患者的治疗结果至关重要。我们应用了基于我们的数据库开发的定制化ASCOT模型，作为评判一家当地医院护理质量的工具。
总共4096例创伤患者被用于制定ASCOT定制化的新系数。这些患者被随机分为两组。ASCOT的新系数源自第一组患者。新开发的模型在第二组患者中进行验证，并计算辨别力指标（ROC曲线下面积）和校准指标（Hosmer-Lemeshow拟合优度）。然后我们使用定制模型计算当地医院不同亚组患者的W评分，以评估每组患者所接受的护理。
定制化ASCOT在验证数据集中具有良好的辨别力（ROC曲线下面积 = 0.9575）和校准（Hosmer-Lemeshow拟合优度p值 = 0.7628）。使用定制模型，我们计算了当地医院六个月期间不同亚组患者的W评分。剖腹手术（W = -13.31）和骨盆骨折（W = -5.56）的护理质量最差，骨科手术（W = 1.76）的护理质量最佳。
我们认为，ASCOT模型用于评估当地医院护理质量时进行定制化，有助于发现缺陷并改善为患者提供的护理流程。
