Jones Peter, Le Fevre James, Harper Alana, Wells Susan, Stewart Joanna, Curtis Elana, Reid Papaarangi, Ameratunga Shanthi
Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, Section of Epidemiology and Biostatistics, University of Auckland, Auckland.
Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland.
N Z Med J. 2017 May 12;130(1455):35-44.
To determine whether implementation of a national health target called Shorter Stays in Emergency Departments impacted on clinical markers of quality of care.
A retrospective pre- and post-intervention study from 2006 to 2012 examined quality of care metrics for five different indicators at different sites in relation to the implementation of the target using a general linear model for times to treatment. Explanatory variables included period (pre- or post-target), ethnicity, age, deprivation and severity of condition. Back transformed least square means were used to describe the outcomes.
The times to treatment for ST elevation myocardial infarction; 36.9 (28-49) vs 47.6 (36-63) minutes p=0.14, antibiotics for severe sepsis; 105.9 (73-153) vs 104.3 (70-155) minutes p=0.93, analgesia for moderate or severe pain; 48 (31-75) vs 46 (32-66) minutes p =0.77, theatre for fractured neck of femur; 35.4 (32.1-39.1) vs 32.4 (29.2-36.1) hours, and to theatre for appendicitis; 14.1 (12-17) vs 16.4 (14-20) hours were unchanged after implementation of the target. Treatment adequacy was also unchanged for these indicators.
Introduction of the Shorter Stays in Emergency Departments target was not associated with any clinically important or statistically significant changes in the time to treatment and adequacy of care for five different clinical indicators of quality of care in Aotearoa New Zealand. For those indicators measured at one site only, it is unknown whether these results can be generalised to other sites.
确定一项名为“缩短急诊科留观时间”的国家卫生目标的实施是否对医疗质量的临床指标产生影响。
一项2006年至2012年的干预前后回顾性研究，使用治疗时间的一般线性模型，在不同地点针对该目标的实施情况，对五个不同指标的医疗质量指标进行了检查。解释变量包括时期（目标实施前或后）、种族、年龄、贫困程度和病情严重程度。采用反向转换的最小二乘均值来描述结果。
ST段抬高型心肌梗死的治疗时间：36.9（28 - 49）分钟对47.6（36 - 63）分钟，p = 0.14；严重脓毒症使用抗生素的时间：105.9（73 - 153）分钟对104.3（70 - 155）分钟，p = 0.93；中度或重度疼痛的镇痛时间：48（31 - 75）分钟对46（32 - 66）分钟，p = 0.77；股骨颈骨折的手术时间：35.4（32.1 - 39.1）小时对32.4（29.2 - 36.1）小时，以及阑尾炎的手术时间：14.1（12 - 17）小时对16.4（14 - 20）小时，在目标实施后均未改变。这些指标的治疗充分性也未改变。
在新西兰奥特亚罗瓦，“缩短急诊科留观时间”目标的引入与五个不同医疗质量临床指标的治疗时间和护理充分性方面的任何临床重要或统计学显著变化均无关联。对于仅在一个地点测量的那些指标，尚不清楚这些结果是否可推广到其他地点。
