多州质量改进运动在降低髋膝关节置换术后手术部位感染风险中的效果。
Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty.
机构信息
Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA.
出版信息
BMJ Qual Saf. 2019 May;28(5):374-381. doi: 10.1136/bmjqs-2018-007982. Epub 2018 Oct 8.
BACKGROUND
Quality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied.
OBJECTIVE
To assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement's Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices.
METHODS
We analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states. We used generalised linear mixed effects models and a difference-in-differences approach to estimate changes in SSI outcomes.
RESULTS
125 070 patients underwent hip arthroplasty in 405 hospitals in intervention states, compared with 131 787 in 525 hospitals in comparison states. 170 663 patients underwent knee arthroplasty in 397 hospitals in intervention states, compared with 196 064 in 518 hospitals in comparison states. After the campaign, patients in intervention states had a 15% lower odds of developing hip arthroplasty SSIs (OR=0.85, 95% CI 0.75 to 0.96, p=0.01) and a 12% lower odds of knee arthroplasty SSIs than patients in comparison states (OR=0.88, 95% CI 0.78 to 0.99, p=0.04).
CONCLUSIONS
A larger reduction of SSI rates following hip and knee arthroplasty was shown in intervention states than in matched control states.
背景
质量改进（QI）活动似乎增加了循证实践的应用，但它们对健康结果的影响研究较少。
目的
评估一项多州 QI 活动（项目 JOINTS，联合组织解决 SSIs）的效果，该活动利用了医疗机构改进研究所的快速传播网络来促进采用循证手术部位感染（SSI）预防措施。
方法
我们分析了在参与多州 JOINTS 项目试验的五个州和五个匹配的对照组中，接受髋关节和膝关节置换术的 Medicare 受益人的 SSI 发生率，分别在干预前（2010 年 5 月至 2011 年 4 月）和干预后（2011 年 11 月至 2013 年 9 月）期间。我们使用广义线性混合效应模型和差异中的差异方法来估计 SSI 结果的变化。
结果
在干预州的 405 家医院中，有 125070 名患者接受了髋关节置换术，而在对照组的 525 家医院中，有 131787 名患者接受了髋关节置换术。在干预州的 397 家医院中，有 170663 名患者接受了膝关节置换术，而在对照组的 518 家医院中，有 196064 名患者接受了膝关节置换术。在活动之后，与对照组相比，干预州的髋关节置换术 SSI 发生率降低了 15%（OR=0.85，95%CI 0.75 至 0.96，p=0.01），膝关节置换术 SSI 发生率降低了 12%（OR=0.88，95%CI 0.78 至 0.99，p=0.04）。
结论
与匹配的对照组相比，髋关节和膝关节置换术后 SSI 发生率的下降幅度在干预州更大。
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