Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin City, 150081, Heilongjiang Province, China.
Sci Rep. 2024 Aug 19;14(1):19137. doi: 10.1038/s41598-024-70474-8.
Reporting the results of quality indicators can narrow the gap in the quality of care between hospitals. While most studies rely on outcome indicators, they may not accurately measure the quality of care. Process indicators are not only strongly associated with treatment outcomes, but are also more sensitive to whether patients are treated accurately, enabling timely intervention. Our study aims to investigate whether process indicators provide a more reasonable assessment of hospital quality of care compared to outcome indicators. Data were sourced from the Specific Disease Medical Service Quality Management and Control System in China. A total of 113,942 patients with breast cancer treated in 298 hospitals between January 2019 and April 2023 were included in this retrospective study. The rankability of 11 process indicators was calculated and used as a weight to create a new composite indicator. The composite indicators and outcome measures were compared using the O/E ratio categories. Finally, in order to determine the impact of different years on the results, a sensitivity analysis was conducted using bootstrap sampling. The rankability ( ) values of the eleven process indicators showed significant differences, with the highest value for preoperative cytological or histological examination before surgery (0.919). The value for the outcome indicator was 0.011. The rankability-weighting method yielded a comprehensive score ( = 0.883). The comparison with categorical results of the outcome indicator has different performance classifications for 113 hospitals (37.92%) for composite scores and 140 (46.98%) for preoperative cytological or histological examinationbefore surgery. Process indicators are more suitable than outcome indicators for assessing the quality of breast cancer care in hospitals. Healthcare providers can use process indicators to identify specific areas for improvement, thereby driving continuous quality improvement efforts.
报告质量指标的结果可以缩小医院间护理质量的差距。虽然大多数研究依赖于结果指标，但它们可能无法准确衡量护理质量。过程指标不仅与治疗结果密切相关，而且对患者是否得到准确治疗也更为敏感，能够及时进行干预。我们的研究旨在探讨过程指标与结果指标相比，是否能更合理地评估医院的护理质量。数据来源于中国特定疾病医疗服务质量监测与控制系统。共有 298 家医院 2019 年 1 月至 2023 年 4 月期间治疗的 113942 例乳腺癌患者纳入本回顾性研究。计算了 11 个过程指标的可排名性（ ）值，并将其用作权重来创建新的综合指标。使用 O/E 比值类别对综合指标和结果指标进行比较。最后，为了确定不同年份对结果的影响，采用 bootstrap 抽样进行敏感性分析。11 个过程指标的可排名性（ ）值存在显著差异，术前手术前细胞学或组织学检查的 值最高（0.919）。结果指标的 值为 0.011。综合指标的排名加权法得到了一个综合得分（ = 0.883）。与结果指标的分类结果进行比较，113 家医院的综合评分有不同的表现分类（37.92%），140 家医院的术前细胞学或组织学检查有不同的表现分类（46.98%）。过程指标比结果指标更适合评估医院乳腺癌护理质量。医疗保健提供者可以使用过程指标来确定需要改进的具体领域，从而推动持续质量改进工作。
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