Crimmins Mary M, Lowe Timothy J, Barrington Monica, Kaylor Courtney, Phipps Terri, Le-Roy Charlene, Brooks Tammy, Jones Mashekia, Martin John
Jt Comm J Qual Patient Saf. 2016 Jun;42(6):247-53. doi: 10.1016/s1553-7250(16)42032-5.
In 2008 Premier (Premier, Inc., Charlotte, North Carolina) began its Quality, Efficiency, and Safety with Transparency (QUEST®) collaborative, which is an acute health care organization program focused on improving quality and reducing patient harm.
Retrospective performance data for QUEST hospitals were used to establish trends from the third quarter (Q3; July–September) of 2006 through Q3 2015. The study population included past and present members of the QUEST collaborative (N = 356), with each participating hospital considered a member. The QUEST program engages with member hospitals through a routine-coaching structure, sprints, minicollaboratives, and face-to-face meetings.
Cost and efficiency data showed reductions in adjusted cost per discharge for hospitals between Q3 2013 (mean, $8,296; median, $8,459) and Q3 2015 (mean, $8,217; median, $7,895). Evidence-based care (EBC) measures showed improvement from baseline (Q3 2006; mean, 77%; median, 79%) to Q3 2015 (mean, 95%; median, 96%). Observed-to-expected (O/E) mortality improved from 1% to 22% better-than-expected outcomes on average. The QUEST safety harm composite score showed moderate reduction from Q1 2009 to Q3 2015, as did the O/E readmission rates--from Q1 2010 to Q3 2015--with improvement from a 5% to an 8% better-than-expected score.
Quantitative and qualitative evaluation of QUEST collaborative hospitals indicated that for the 2006-2015 period, QUEST facilities reduced cost per discharge, improved adherence with evidence-based practice, reduced safety harm composite score, improved patient experience, and reduced unplanned readmissions.
2008年，Premier公司（位于北卡罗来纳州夏洛特市的Premier公司）启动了“透明化质量、效率与安全”（QUEST®）合作项目，这是一个专注于提高医疗质量和减少患者伤害的急性医疗保健组织项目。
利用QUEST医院的回顾性绩效数据来确定2006年第三季度（Q3；7月至9月）至2015年Q3的趋势。研究人群包括QUEST合作项目的过去和现在成员（N = 356），每个参与医院被视为一个成员。QUEST项目通过常规辅导结构、冲刺、小型合作和面对面会议与成员医院合作。
成本和效率数据显示，2013年Q3（平均8296美元；中位数8459美元）至2015年Q3（平均8217美元；中位数7895美元）期间，医院每例出院调整成本有所降低。循证护理（EBC）指标显示从基线（2006年Q3；平均77%；中位数79%）到2015年Q3（平均95%；中位数96%）有所改善。观察到的与预期的（O/E）死亡率平均从1%提高到比预期结果好22%。QUEST安全危害综合评分从2009年Q1到2015年Q3有适度下降，O/E再入院率也是如此——从2010年Q1到2015年Q3——从比预期评分好5%提高到8%。
对QUEST合作医院的定量和定性评估表明，在2006 - 2015年期间，QUEST机构降低了每例出院成本，提高了循证实践的依从性，降低了安全危害综合评分，改善了患者体验，并减少了非计划再入院率。
