Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, the Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, and the State University of New York Downstate, Brooklyn, New York.
Obstet Gynecol. 2018 Sep;132(3):750-753. doi: 10.1097/AOG.0000000000002791.
The Adverse Outcome Index, originally designed to provide an objective inventory of adverse outcomes, is often promoted as a tool for assessing the quality of inpatient obstetric care. Although the Adverse Outcome Index is well described, and its outcomes are easy to collect, it has notable drawbacks such as "paradoxical measures" (eg, blood transfusions are counted as adverse measures even when they are used appropriately) and the dominance of certain measures within the Adverse Outcome Index that can drive scores (eg, neonatal intensive care unit admissions). In this article, we argue that in addition to the limitations noted, the Adverse Outcome Index, although providing a reasonable measure of inpatient obstetric acuity, fails to be a reliable measure of quality. This is particularly important because many organizations are seeking quality measures and the Adverse Outcome Index may become a candidate tool. We believe that introducing an adjudication process to the Adverse Outcome Index would greatly enhance its role as a quality indicator. Until newly proposed quality measures are perfected and adopted, a quality-adjusted Adverse Outcome Index will allow this widely used measure to provide a more reliable determination of those adverse events potentially amenable to performance improvement.
不良结局指数最初旨在提供不良结局的客观清单，常被推广为评估住院产科护理质量的工具。尽管不良结局指数描述得很好，其结局也易于收集，但它有显著的缺点，如“矛盾的措施”（例如，即使输血是合理使用的，也被算作不良措施）和某些措施在不良结局指数中的主导地位，这些措施可能会影响评分（例如，新生儿重症监护病房入院）。在本文中，我们认为，除了已注意到的局限性外，不良结局指数虽然提供了一种合理的住院产科严重程度的衡量标准，但不能作为质量的可靠衡量标准。这一点尤为重要，因为许多组织都在寻求质量衡量标准，而不良结局指数可能成为候选工具。我们认为，为不良结局指数引入裁决程序将极大地增强其作为质量指标的作用。在新提出的质量衡量标准完善并采用之前，一个经过质量调整的不良结局指数将使这一广泛使用的衡量标准能够更可靠地确定那些可能需要改进绩效的不良事件。
