Ramos Sara D S, Coetzer Rudi
Brainkind, Wakefield WF5 9TJ, UK.
Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK.
Behav Sci (Basel). 2023 Aug 25;13(9):705. doi: 10.3390/bs13090705.
Practitioners have a clinical, ethical, academic, and economic responsibility to dispassionately consider how effective their services are. Approaches to measure how "good" or "bad" healthcare is include clinical audit, satisfaction surveys, and routine outcome measurement. However, the process of comparing the clinical outcomes of a specific service against the 'best' services in the same specialism, also known as benchmarking, remains challenging, and it is unclear how it affects quality improvement. This paper piloted and compared two different approaches to benchmarking to assess clinical outcomes in neurorehabilitation. Norming involved comparing routine measures of clinical outcome with external validators. Stacking involved pooling and comparing internal data across several years. The analyses of routine clinical outcome data from 167 patients revealed significant differences in the patient characteristics of those admitted to the same service provider over time, but no differences in outcomes achieved when comparing with historical data or with external reference data. These findings illustrate the potential advantages and limitations of using stacking and norming to benchmark clinical outcomes, and how the results from each approach might be used to evaluate service effectiveness and inform quality improvement within the field of brain injury rehabilitation.
从业者有临床、伦理、学术和经济责任去冷静思考他们的服务效果如何。衡量医疗保健“好”或“坏”的方法包括临床审计、满意度调查和常规结果测量。然而，将特定服务的临床结果与同一专业领域的“最佳”服务进行比较的过程，也就是所谓的基准测试，仍然具有挑战性，而且目前尚不清楚它如何影响质量改进。本文试点并比较了两种不同的基准测试方法，以评估神经康复中的临床结果。规范法是将临床结果的常规测量与外部验证者进行比较。堆叠法是汇总并比较多年的内部数据。对167例患者的常规临床结果数据进行分析后发现，随着时间推移，同一服务提供者收治的患者特征存在显著差异，但与历史数据或外部参考数据相比，所取得的结果并无差异。这些发现说明了使用堆叠法和规范法进行临床结果基准测试的潜在优势和局限性，以及每种方法的结果如何用于评估服务效果并为脑损伤康复领域的质量改进提供参考。
