Ido Moges S, Frankel Michael R, Okosun Ike S, Rothenberg Richard B
1 Georgia State University, Atlanta, GA.
2 Georgia Department of Public Health, Atlanta, GA.
Am J Med Qual. 2018 Jan/Feb;33(1):86-92. doi: 10.1177/1062860617696578. Epub 2017 Mar 18.
Although performance measures help monitor the process change in quality improvement, their utility in measuring long-term outcomes is uncertain. This study assessed the 1-year mortality of acute ischemic stroke patients treated by hospitals participating in the Georgia Coverdell Acute Stroke Registry. Using 10 nationally approved performance measures, quality of care was defined both as an all-or-none measure (defect-free care) and as a composite index. A generalized estimating equation was applied to assess the effect of quality of care on 1-year mortality. Defect-free care did not serve the purpose; however, the composite measure showed that patients who received the lowest and intermediate quality care, respectively, had a 3.94 (95% confidence interval: 3.27, 4.75; P < .0001) and a 1.38 (95% confidence interval: 1.12, 1.62; P = .002) times higher odds of dying in 1 year compared to those who got the best-quality stroke care. Therefore, hospitals should be encouraged to implement quality improvement activities for better long-term patient outcome.
尽管绩效指标有助于监测质量改进过程中的变化，但其在衡量长期结果方面的效用尚不确定。本研究评估了参与佐治亚州科弗代尔急性卒中登记处的医院所治疗的急性缺血性卒中患者的1年死亡率。使用10项国家认可的绩效指标，将护理质量定义为全有或全无指标（无缺陷护理）和综合指数。应用广义估计方程来评估护理质量对1年死亡率的影响。无缺陷护理未达到目的；然而，综合指标显示，分别接受最低质量和中等质量护理的患者在1年内死亡的几率比接受最佳质量卒中护理的患者高3.94倍（95%置信区间：3.27，4.75；P <.0001）和1.38倍（95%置信区间：1.12，1.62；P =.002）。因此，应鼓励医院开展质量改进活动，以实现更好的患者长期预后。
