Shroyer A L, London M J, Sethi G K, Marshall G, Grover F L, Hammermeister K E
Department of Cardiac Research, Denver Veterans Administration Medical Center, Colorado 80220, USA.
Med Care. 1995 Oct;33(10 Suppl):OS26-34. doi: 10.1097/00005650-199510001-00004.
The processes, Structures, and Outcomes of Care in Cardiac Surgery (PSOCS) study involves data collection on a comprehensive array of patient risk factors, processes, structures, and short-term outcomes of care at 14 participating Veterans Administration medical centers. This article summarizes the PSOCS conceptual models that serve as the theoretical framework for analyzing the hypothesized risk-process-structure-outcome relationships being investigated. The PSOCS data set includes more than 1,100 variables related to each patient and more than 300 variables related to provider-specific and facility-specific characteristics. This massive data set presents a formidable analytic challenge. The conceptual modeling process involved four-steps: 1) establishing a vision of the general conceptual model defining the overall risk-process-structure-outcome relationships, 2) developing specific hypotheses or subhypotheses, 3) visualizing a hierarchical set of dimensions and subdimensions, and 4) uniquely assigning each variable collected in the study to a dimension or subdimension for purposes of testing the study's primary hypotheses. A multidisciplinary team participated in this modeling process. The goal of the conceptual modeling process is to identify clearly the actions (ie, the changes in either processes or structures that are linked to risk-adjusted patient outcomes) that can be taken by clinicians, management, and policymakers to improve the quality of cardiac surgical care.
心脏手术护理的过程、结构与结果（PSOCS）研究涉及在14家参与研究的退伍军人管理局医疗中心收集一系列全面的患者风险因素、护理过程、结构及短期结果的数据。本文总结了PSOCS概念模型，这些模型作为理论框架，用于分析正在研究的假设性风险-过程-结构-结果关系。PSOCS数据集包含1100多个与每位患者相关的变量以及300多个与医疗服务提供者特定和机构特定特征相关的变量。这个庞大的数据集带来了巨大的分析挑战。概念建模过程包括四个步骤：1）确立定义总体风险-过程-结构-结果关系的一般概念模型的愿景；2）提出具体假设或子假设；3）可视化一组分层的维度和子维度；4）为检验研究的主要假设，将研究中收集的每个变量唯一地分配到一个维度或子维度。一个多学科团队参与了这个建模过程。概念建模过程的目标是明确临床医生、管理人员和政策制定者可以采取哪些行动（即与风险调整后的患者结果相关的过程或结构的变化）来提高心脏手术护理质量。
