Hartz A J, Sigmann P, Guse C, Hagen T C
Family and Community Medicine, Medical College of Wisconsin, Milwaukee 53226.
Jt Comm J Qual Improv. 1994 Mar;20(3):140-51. doi: 10.1016/s1070-3241(16)30057-8.
The Health Care Financing Administration designed the Uniform Clinical Data Set System (UCDSS) to help peer review organizations (PROs) identify problems with patient care. The system currently is being piloted in five states and may be used for the PRO review of Medicare patients from all states by January 1995. This study tested whether UCDSS could be used with modifications for effective internal hospital quality review.
The UCDSS includes a computer program for collecting information from the medical record and 359 computerized algorithms that evaluate quality of care. For this study, 2,313 randomly chosen medical records from a tertiary care teaching hospital were abstracted with the UCDSS at the time of discharge. Cases flagged by the UCDSS algorithms as having potential quality-of-care problems were referred to a clinical reviewer to evaluate whether the flag was a true positive and to identify reasons for false-positive flags. The algorithms were modified based on this hospital's experience by adding the reasons for false-positive flags as exceptions to the algorithm rules.
To abstract the data with the UCDSS required a median time of 45 minutes and a mean time of 55 minutes per medical record. The percentages of algorithm flags that were confirmed upon physician review to have a quality problem were estimated to be 21% for the UCDSS and 43% for the modified UCDSS. The confirmed problem rate varied substantially by algorithm. Confirmed problems were the source of numerous departmental and individual discussions and led to changes in five departmental procedures.
Although the results of this study are preliminary and require further verification, they suggest that with modifications and careful attention to implementation, the UCDSS may be an expensive but potentially useful tool for in-hospital quality review. In-hospital employment of the UCDSS offers more opportunities for practical use of algorithms for continuous quality improvement rather than the sometimes punitive use of system findings by PROs.
医疗保健财务管理局设计了统一临床数据集系统（UCDSS），以帮助同行评审组织（PRO）识别患者护理问题。该系统目前正在五个州进行试点，到1995年1月可能用于对来自所有州的医疗保险患者进行PRO评审。本研究测试了UCDSS是否可以通过修改用于有效的医院内部质量评审。
UCDSS包括一个用于从病历中收集信息的计算机程序和359个评估护理质量的计算机算法。在本研究中，在出院时使用UCDSS从一家三级护理教学医院随机抽取了2313份病历。UCDSS算法标记为有潜在护理质量问题的病例被提交给临床评审员，以评估该标记是否为真阳性，并确定假阳性标记的原因。根据该医院的经验，通过将假阳性标记的原因作为算法规则的例外情况添加进来，对算法进行了修改。
使用UCDSS提取数据每份病历所需的中位时间为45分钟，平均时间为55分钟。经医生评审确认存在质量问题的算法标记百分比估计，UCDSS为21%，修改后的UCDSS为43%。确认的问题率因算法而异。确认的问题引发了众多部门和个人的讨论，并导致五个部门的程序发生了变化。
尽管本研究的结果是初步的，需要进一步验证，但它们表明，通过修改并仔细关注实施情况，UCDSS可能是一种昂贵但潜在有用的医院内部质量评审工具。在医院内部使用UCDSS为持续质量改进算法的实际应用提供了更多机会，而不是PRO有时对系统结果的惩罚性使用。
