Farjah Farhood
Division of Cardiothoracic Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356310, Seattle, WA 98195, USA.
Thorac Surg Clin. 2017 Aug;27(3):257-266. doi: 10.1016/j.thorsurg.2017.03.005. Epub 2017 May 22.
Variability in outcomes not attributable to case mix or chance is an indicator of low-quality care. Failure-to-rescue is an outcome measure defined as death during a hospitalization among patients who experience a complication. Researchers have used this measure to better understand the determinants of an untimely death-preventing complications, rescue, or both. Studies repeatedly find that complication rates vary little, if at all, across hospitals ranked by risk-adjusted mortality rates, suggesting that hospitals are equally capable (or incapable) of preventing complications. In contrast, variation in failure-to-rescue rates seems to explain much of the variation in risk-adjusted hospital-level mortality rates. These findings suggest that system-level interventions that allow for the early detection and treatment of complications (ie, rescue) may reduce variability in hospital-level outcomes and improve the quality of thoracic surgical care.
并非由病例组合或随机因素导致的结果差异是低质量医疗的一个指标。未能挽救是一种结果衡量指标，定义为发生并发症的患者在住院期间死亡。研究人员使用这一指标来更好地理解导致过早死亡的决定因素——预防并发症、进行挽救或两者兼顾。研究反复发现，按风险调整后的死亡率排名的医院，其并发症发生率几乎没有差异，这表明各医院在预防并发症方面的能力相当（或相当缺乏）。相比之下，未能挽救率的差异似乎可以解释风险调整后的医院层面死亡率差异的很大一部分。这些发现表明，能够实现并发症早期检测和治疗（即挽救）的系统层面干预措施可能会减少医院层面结果的差异，并提高胸外科护理质量。
