质量保证措施与卒后死亡率。
Quality Assurance Measures and Mortality After Stroke.
机构信息
Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg; Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr University Bochum; Department of Neurology, University Hospital of Giessen/Marburg, Justus Liebig University of Giessen; Institute of Epidemiology and Social Medicine, Medical Faculty, Westphalian Wilhelms University of Münster; Quality Assurance Office Hesse (GQH), Hessian Hospital Society; Research Institute of the AOK [German public health insurance company], AOK Federal Association.
出版信息
Dtsch Arztebl Int. 2021 Dec 17;118(50):857-863. doi: 10.3238/arztebl.m2021.0339.
BACKGROUND
Quality assurance for acute in-hospital care in Germany is based on compulsory comparisons between institutions, so-called external quality assurance (EQA). The effectiveness of EQA has not yet been adequately studied. The purpose of the QUASCH project, which is supported by the Innovation Fund of the Federal Joint Committee, is to investigate the association between EQA and health care outcomes, specifically with respect to stroke.
METHODS
The analyses were based on data from 379 825 patients insured by the AOK health insurance fund who were acutely admitted to a hospital because of stroke over the period 2007-2017. Data on 47 659 patients were derived from EQA documentation in the state of Hesse, in which stroke EQA had already been introduced in 2003; data on the remaining 332 166 patients were from other federal states, where 117 734 of these patients had been treated under EQA conditions. The association of EQA with mortality over the period of observation was analyzed by multivariate Cox regression, with the following covariates: age, sex, comorbidities, time period of occurrence, nursing care level, type of stroke, socio-economic deprivation in the region of origin, and treatment in a stroke unit.
RESULTS
Compared to treatment without EQA, mortality risk under EQA in the state of Hesse was significantly lower (hazard ratio [HR]: 0.93; 95% confidence interval: [0.92; 0.95]). The reduction in mortality risk with EQA was somewhat lower in the other federal states (HR: 0.96 [0.95; 0.97]). Treatment in a stroke unit was associated with a mortality risk that was lower still (HR: 0.86 [0.85; 0.87]). Mortality risk rose with age, comorbidities, and need for nursing care; it was lower in women and in persons whose stroke occurred in a later period.
CONCLUSION
Quality assurance measures are associated with lower mortality risk after stroke. The concentration of care in specially qualified institutions is associated with stronger effects than EQA alone.
背景
德国的急性院内护理质量保证基于机构之间的强制性比较，即所谓的外部质量保证（EQA）。EQA 的有效性尚未得到充分研究。由联邦联合委员会创新基金支持的 QUASCH 项目旨在研究 EQA 与医疗保健结果之间的关联，特别是在中风方面。
方法
分析基于 2007 年至 2017 年期间因中风而急性住院的 AOK 健康保险基金承保的 379825 名患者的数据。来自黑森州 EQA 文档的数据涉及 47659 名患者，该州已于 2003 年引入中风 EQA；其余 332166 名患者的数据来自其他联邦州，其中 117734 名患者在 EQA 条件下接受了治疗。通过多变量 Cox 回归分析 EQA 与观察期内死亡率的关联，协变量包括年龄、性别、合并症、发病时间、护理水平、中风类型、原籍地区的社会经济贫困程度以及中风单元的治疗。
结果
与无 EQA 治疗相比，黑森州 EQA 治疗下的死亡率风险显著降低（风险比[HR]：0.93；95%置信区间[0.92；0.95]）。在其他联邦州，EQA 降低死亡率的风险略低（HR：0.96 [0.95；0.97]）。在中风单元接受治疗的患者的死亡率风险更低（HR：0.86 [0.85；0.87]）。死亡率风险随年龄、合并症和护理需求的增加而上升；女性和中风发生在后期的患者的死亡率风险较低。
结论
质量保证措施与中风后死亡率风险降低相关。与单独的 EQA 相比，将护理集中在专门合格的机构中与更强的效果相关。
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