Charles Ryan J, Singal Bonita M, Urquhart Andrew G, Masini Michael A, Hallstrom Brian R
Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, Michigan; Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) Coordinating Center, University of Michigan Medical Center, Ann Arbor, Michigan.
J Arthroplasty. 2017 May;32(5):1418-1425. doi: 10.1016/j.arth.2016.11.041. Epub 2016 Nov 28.
The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals.
The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time.
This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes.
Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions.
自2012年成立以来，密歇根关节置换登记协作质量改进计划（MARCQI）一直在监测全髋关节和膝关节置换术后的出院处置情况，并发现不同医院之间，入住长期护理机构（ECF）的标准化风险差异很大。
将MARCQI成员机构之间ECF安置标准化风险的差异报告给协作组。在2014年5月2日的季度会议上，启动了一项质量改进计划，强调了医院之间的巨大差异、医院和外科医生对这种差异的贡献（使用中位数优势比），以及异常值医院启动质量改进（QI）流程的必要性。本分析纳入了干预前MARCQI成员的29家医院的患者。我们比较了整个队列以及3家实施特定机构QI项目的医院在干预前后的标准化风险。我们报告了随着时间推移，ECF安置、住院时间、急诊就诊和再入院情况的变化。
本研究纳入了质量改进计划实施前的31347名患者和实施后的20879名患者。标准化风险范围从9.4%-46.1%降至9.4%-32.4%，平均风险从23.0%降至19.6%。三家异常值医院在QI后，其ECF安置的绝对风险分别降低了12.2%、8.9%和12.4%，且不良结局未增加。
初次髋关节和膝关节置换术后入住ECF的情况差异很大，且受医院和外科医生的操作影响。医院层面的QI措施可减少ECF入院人数。
