Layani Géraldine, Fleet Richard, Dallaire Renée, Tounkara Fatoumata K, Poitras Julien, Archambault Patrick, Chauny Jean-Marc, Ouimet Mathieu, Gauthier Josée, Dupuis Gilles, Tanguay Alain, Lévesque Jean-Frédéric, Simard-Racine Geneviève, Haggerty Jeannie, Légaré France
Research Chair in Emergency Medicine Université Laval - Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis (Layani, Fleet, Dallaire, Tounkara, Archambault, Tanguay), Lévis; Department of Family and Emergency Medicine (Fleet, Poitras, Archambault); Intensive Care Division (Archambault), Department of Anesthesiology, Université Laval, Québec; Department of Family and Emergency Medicine (Chauny), Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal; Department of Political Science (Ouimet), Université Laval, Québec; Health Care Services Systems Analysis and Evaluation Directorate(Gauthier), Quebec Public Health Institute, Université du Québec à Rimouski, Rimouski; Department of Psychology (Dupuis), Université du Québec à Montréal, Montréal, Que.; Centre for Primary Health Care and Equity (Lévesque), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Emergency Medicine (Simard-Racine), Centre de santé et de services sociaux de La Matapédia, Amqui; McGill Chair in Family and Community Medicine Research (Haggerty), St. Mary's Hospital Centre and McGill University, Montréal; Department of Family Medicine and Emergency Medicine and Knowledge Transfer and Health Technology Assessment Group, Centre hospitalier universitaire de Québec Research Centre (Légaré), Evaluative Research Unit, Université Laval, Québec, Que.
CMAJ Open. 2016 Aug 3;4(3):E398-E403. doi: 10.9778/cmajo.20160007. eCollection 2016 Jul-Sep.
Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec.
We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013.
Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators.
Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.
基于证据的医疗质量指标已被制定出来，以改善加拿大急诊科的医疗服务和绩效。这些指标测量的可行性主要在城市和学术性急诊科进行了评估。我们试图评估在魁北克农村急诊科测量医疗质量指标的可行性。
我们之前确定了魁北克的农村急诊科，这些急诊科每周7天、每天24小时提供有床位的医疗服务，且位于加拿大统计局定义的农村地区或小镇。向每个急诊科发送了一份标准化方案，以收集8个类别中27个经过验证的医疗质量指标的数据：住院时间、患者安全、疼痛管理、儿科、心脏病学、呼吸护理、中风和脓毒症/感染。数据由当地专业医学档案管理员在2013年6月至12月期间收集。
受邀参与的26个急诊科中有15个（58%）完成了数据收集。各部门使用数据库测量27个医疗质量指标的能力各不相同。2号、5号、6号和13号中心至少对21个指标（78%-92%）使用了数据库，而3号、8号、9号、11号、12号和15号中心对5个（18%）或更少的指标使用了数据库。平均而言，这些中心使用异构数据库和人工提取只能测量41%的指标。这15个中心从15个不同的数据库或数据库组合中收集数据。每个医疗质量指标的平均数据收集时间从5分钟到88.5分钟不等。大多数指标的数据收集时间中位数为15分钟或更短。
在魁北克农村急诊科使用现有数据库不容易获取医疗质量指标。有必要开展进一步工作，以改善该省农村急诊科这些指标的标准化测量，并将本研究收集到的信息推广到其他医疗环境。
