未事先通知与事先通知的医院调查：一项全国性整群随机对照试验。

Unannounced versus announced hospital surveys: a nationwide cluster-randomized controlled trial.

作者信息

Ehlers Lars Holger, Simonsen Katherina Beltoft, Jensen Morten Berg, Rasmussen Gitte Sand, Olesen Anne Vingaard

机构信息

Danish Center for Healthcare Improvements, Department of Business and Management, Fibigerstraede 11, DK-9220, Aalborg University, Aalborg, Denmark.

Center for Research in Econometric Analysis of Time Series, Department of Economics and Business, Aarhus University, Fuglesangs Allé 4, DK-8210 Aarhus V, Denmark.

出版信息

Int J Qual Health Care. 2017 Jun 1;29(3):406-411. doi: 10.1093/intqhc/mzx039.

DOI:10.1093/intqhc/mzx039

PMID:28419255

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5890868/

Abstract

OBJECTIVE

To evaluate the effectiveness of unannounced versus announced surveys in detecting non-compliance with accreditation standards in public hospitals.

DESIGN

A nationwide cluster-randomized controlled trial.

SETTING AND PARTICIPANTS

All public hospitals in Denmark were invited. Twenty-three hospitals (77%) (3 university hospitals, 5 psychiatric hospitals and 15 general hospitals) agreed to participate.

INTERVENTION

Twelve hospitals were randomized to receive unannounced surveys (intervention group) and eleven hospitals to receive announced surveys (control group). We hypothesized that the hospitals receiving the unannounced surveys would reveal a higher degree of non-compliance with accreditation standards than the hospitals receiving announced surveys. Nine surveyors trained and employed by the Danish Institute for Quality and Accreditation in Healthcare (IKAS) were randomized into teams and conducted all surveys.

MAIN OUTCOME MEASURE

The outcome was the surveyors' assessment of the hospitals' level of compliance with 113 performance indicators-an abbreviated set of the Danish Healthcare Quality Programme (DDKM) version 2, covering organizational standards, patient pathway standards and patient safety standards. Compliance with performance indicators was analyzed using binomial regression analysis with bootstrapped robust standard errors.

RESULTS

In all, 16 202 measurements were acceptable for data analysis. The risk of observing non-compliance with performance indicators for the intervention group compared with the control group was statistically insignificant (risk difference (RD) = -0.6 percentage points [-2.51-1.31], P = 0.54). A converged analysis of the six patient safety critical standards, requiring 100% compliance to gain accreditation status revealed no statistically significant difference (RD = -0.78 percentage points [-4.01-2.44], P = 0.99).

CONCLUSIONS

Unannounced hospital surveys were not more effective than announced surveys in detecting quality problems in Danish hospitals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT02348567, https://clinicaltrials.gov/ct2/show/NCT02348567?term=NCT02348567.

摘要

目的

评估突击检查与预先通知检查在发现公立医院不符合认证标准方面的有效性。

设计

一项全国性整群随机对照试验。

设置与参与者

丹麦所有公立医院均被邀请参与。23家医院（77%）（3家大学医院、5家精神病医院和15家综合医院）同意参与。

干预措施

12家医院被随机分配接受突击检查（干预组），11家医院接受预先通知检查（对照组）。我们假设，接受突击检查的医院比接受预先通知检查的医院会暴露出更高程度的不符合认证标准的情况。由丹麦医疗保健质量与认证研究所（IKAS）培训并雇佣的9名调查员被随机分组并进行所有检查。

主要结局指标

结局为调查员对医院符合113项绩效指标情况的评估，这是丹麦医疗保健质量计划（DDKM）第2版的一组简化指标，涵盖组织标准、患者就医流程标准和患者安全标准。使用带有自抽样稳健标准误的二项式回归分析对符合绩效指标的情况进行分析。

结果

总计16202项测量数据可用于分析。干预组与对照组相比，观察到不符合绩效指标的风险在统计学上无显著差异（风险差（RD）=-0.6个百分点[-2.51 - 1.31]，P = 0.54）。对六项要求100%符合才能获得认证资格的患者安全关键标准进行的汇总分析显示，无统计学显著差异（RD = -0.78个百分点[-4.01 - 2.44]，P = 0.99）。