Oddone E Z, Weinberger M, Horner M, Mengel C, Goldstein F, Ginier P, Smith D, Huey J, Farber N J, Asch D A, Loo L, Mack E, Hurder A G, Henderson W, Feussner J R
Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC 27705, USA.
J Gen Intern Med. 1996 Oct;11(10):597-607. doi: 10.1007/BF02599027.
To describe a new quality assessment method used to classify the preventability of hospitalization in terms of patient, clinician, or system factors.
The instrument was developed in two phases. Phase 1 was a prospective comparison of admitting residents' and their attending physicians' classifications of the perceived preventability of consecutive admissions to one Veterans Affairs Medical Center (VAMC) excluding admissions to the intensive care unit (ICU). In phase 2, a panel of 10 physicians rated 811 abstracted records of readmissions from nine VAMCs.
Nine VAMCs across the United States with varying degrees of university hospital affiliation.
Phase 1, 156 patients admitted to the general medicine service at the Durham VAMC. Phase 2, 514 patients accounting for 811 readmissions within 6 months of a general medicine service discharge at nine VAMCs.
Physicians used a checklist to record the reason for hospitalization, the preventability of the hospitalization, and, if preventable, a reason defining preventability, which was classified in terms of system, clinician, and patient factors. In phase 2, two physician panelists assessed preventability for each chart. When two panelists disagreed on the preventability of hospitalization, a third panelist, blind to the original assessments, rated the chart. In phase 1, residents and attending physicians rated 33% and 34% of admissions as preventable (kappa = 0.41), respectively. In phase 2, 277 (34%) of 811 readmissions were deemed preventable. Intraobserver accuracy for the assessment of preventability was 96% (kappa = 0.89). interobserver accuracy was 73% (kappa = 0.43). Hospital system factors accounted for 37% of preventable readmissions, clinician factors for 38%, and patient factors for 21%. The nine hospitals differed markedly in their profile of reasons for preventable readmissions (p = .005).
Using a new method of determining the preventability of hospitalizations, we identified several factors that might avert hospitalizations. Focusing efforts to identify preventable hospitalizations may yield better methods for managing patients' total health care needs; however, the content of those efforts will vary by institution.
描述一种新的质量评估方法，该方法用于根据患者、临床医生或系统因素对住院的可预防性进行分类。
该工具分两个阶段开发。第一阶段是对一家退伍军人事务医疗中心（VAMC）（不包括重症监护病房（ICU）的入院患者）连续入院的可预防性，由住院医师及其主治医生进行前瞻性比较。在第二阶段，一个由10名医生组成的小组对来自9家VAMC的811份再入院摘要记录进行评分。
美国9家不同程度隶属于大学医院的VAMC。
第一阶段，达勒姆VAMC普通内科收治的156例患者。第二阶段，9家VAMC普通内科出院后6个月内514例患者的811次再入院。
医生使用一份清单记录住院原因、住院的可预防性，以及如果可预防，定义可预防性的原因，这些原因根据系统、临床医生和患者因素进行分类。在第二阶段，两名医生小组成员对每份病历的可预防性进行评估。当两名小组成员对住院的可预防性意见不一致时，第三名小组成员在不知道原始评估结果的情况下对病历进行评分。在第一阶段，住院医师和主治医生分别将33%和34%的入院病例评为可预防（kappa = 0.41）。在第二阶段，811次再入院中有277次（34%）被认为是可预防的。评估可预防性的观察者内准确率为96%（kappa = 0.89）。观察者间准确率为73%（kappa = 0.43）。医院系统因素占可预防再入院的37%，临床医生因素占38%，患者因素占21%。9家医院可预防再入院的原因概况差异显著（p = 0.005）。
通过使用一种确定住院可预防性的新方法，我们确定了几个可能避免住院的因素。集中精力识别可预防的住院情况可能会产生更好的方法来满足患者的整体医疗需求；然而，这些工作的内容因机构而异。
