Farmer R G, Marx D, Roithova Z
Department of Medicine, Georgetown University Medical Center, Washington DC 20007-2197, USA.
Int J Qual Health Care. 1996 Dec;8(6):577-82. doi: 10.1093/intqhc/8.6.577.
This was the first attempt of the association representing all acute care hospitals in the Czech Republic to collect mutual data which might be used for quality assurance (QA) purposes and which might lead to the development of national standards of care which could be used for hospital accreditation. Data collected included information which was available universally and which could be measured; in addition, information was intended to be similar in each hospital. In most cases, the data collection systems were based on financial information and data had to be identified which might be used for QA purposes, rather than being able to design a system specific for QA purposes.
Since the hospital payment system was established in 1992, hospitals have had to develop data collection systems to measure clinical activity; this current study was based on this data collection, adapted to QA purposes.
The Executive Committee of the Hospital Association agreed to a pilot study of hospitals in 1993; data were collected from approximately 40 hospitals, beginning in 1994.
Hospitals were chosen based on their ability to collect data and participate in the program, and it was determined that there should be variability in the hospitals, in size, location and activities, but that the data collected should be generic.
Raw data included 33 different items, most of which were irrelevant to QA. Using a computer program, various combinations of data were reviewed and evaluated to ascertain the most appropriate for QA purposes.
Data were chosen for study which included (a) data from the largest departments in the individual hospitals; (b) length of stay for patients hospitalized in these departments; (c) number of occupied beds/physician in the department and (d) mortality/1000 admissions to the department.
The combination of (1) a long length of stay; (2) a high occupied bed/doctor ratio; and (3) a high mortality rate/1000 admissions might be indicators of poor quality. Additional factors to consider include: the type of department-emergency, cancer, geriatric, etc.; the nature of the medical activity-acute, referral, primary care, etc.; whether or not "social" beds are included and, generally, comparability among departments. However, as a pilot study, certain indicators can be determined which then can be used for future study to determine quality of care. The ability to cooperate and collect seemingly comparable data indicates reason for optimism in the future; more detailed and accurate studies can be carried out which will enable assessment of the quality of care given in comparable situations in hospitals throughout the Czech Republic.
这是代表捷克共和国所有急症护理医院的协会首次尝试收集可用于质量保证（QA）目的的数据，这些数据可能会促成可用于医院认证的国家标准的制定。收集的数据包括普遍可用且可测量的信息；此外，各医院的信息应具有相似性。在大多数情况下，数据收集系统基于财务信息，必须识别出可用于质量保证目的的数据，而非专门设计一个用于质量保证目的的系统。
自1992年医院支付系统建立以来，医院必须开发数据收集系统来衡量临床活动；本研究基于此数据收集，并进行了调整以适应质量保证目的。
医院协会执行委员会于1993年同意对医院进行一项试点研究；从1994年开始，从大约40家医院收集数据。
根据医院收集数据和参与该项目的能力来选择医院，确定医院在规模、位置和活动方面应具有多样性，但收集的数据应具有通用性。
原始数据包括33个不同项目，其中大多数与质量保证无关。使用计算机程序，对各种数据组合进行审查和评估，以确定最适合质量保证目的的数据。
选择用于研究的数据包括：（a）各医院最大科室的数据；（b）这些科室住院患者的住院时间；（c）科室中每张床位/医生的占用率；（d）科室每1000例入院患者的死亡率。
（1）住院时间长；（2）床位/医生占用率高；（3）每1000例入院患者死亡率高这三者的组合可能是质量差的指标。其他需要考虑的因素包括：科室类型——急诊、癌症、老年病等；医疗活动的性质——急性、转诊、初级护理等；是否包括“社会”床位，以及各科室之间的总体可比性。然而，作为一项试点研究，可以确定某些指标，这些指标随后可用于未来研究以确定护理质量。合作收集看似可比数据的能力表明未来有理由保持乐观；可以开展更详细、准确的研究，从而能够评估捷克共和国各地医院在可比情况下提供的护理质量。
