Rosenthal G E, Hammar P J, Way L E, Shipley S A, Doner D, Wojtala B, Miller J, Harper D L
Institute for Health Care Research, Case Western Reserve University, Cleveland, USA.
Jt Comm J Qual Improv. 1998 Jul;24(7):347-60. doi: 10.1016/s1070-3241(16)30386-8.
Cleveland Health Quality Choice is a regional initiative to assess hospital performance which was implemented in 1989. The project developed and validated CHOICE, a severity adjustment system that includes diagnosis-specific models for medical, surgical, and obstetrical patients which are based on clinical data abstracted from patients' medical records.
Since 1992 Cleveland Health Quality Choice has disseminated semi-annual reports that profile hospital mortality rates, lengths of stay, and cesarean section rates using the CHOICE severity adjustment models. Hospitals receive tabular and graphical representations of hospital outcomes and electronic patient-level data files that can be used to further examine outcomes in clinical subgroups.
Four case studies illustrate how outcomes data derived from the CHOICE models led to the development of successful hospital programs to decrease lengths of stay, cesarean section rates, and hospital mortality rates. Although each case study reflected a unique approach to process improvement, several common characteristics were observed: (1) establishment of interdisciplinary process improvement teams with senior physician and nursing leadership; (2) detailed review of the process of care to identify modifiable clinical practices likely to affect outcomes; (3) development of practice guidelines based on group consensus or published recommendations that were designed to affect modifiable practices; and (4) aggressive sharing of serial data with individual practitioners.
Although outcomes data can provide powerful insight on where to target quality improvement efforts, hospitals must identify influential and modifiable clinical practices. Such efforts are most likely to be successful if driven by interdisciplinary work groups, supported by senior clinicians and administrators, and based on locally accepted practice standards.
克利夫兰健康质量选择计划是一项评估医院绩效的区域性倡议，于1989年实施。该项目开发并验证了CHOICE，这是一种严重程度调整系统，包括针对内科、外科和产科患者的特定诊断模型，这些模型基于从患者病历中提取的临床数据。
自1992年以来，克利夫兰健康质量选择计划每半年发布一次报告，使用CHOICE严重程度调整模型概述医院死亡率、住院时间和剖宫产率。医院会收到医院结果的表格和图形表示以及电子患者层面的数据文件，这些文件可用于进一步检查临床亚组的结果。
四个案例研究说明了从CHOICE模型得出的结果数据如何促成了成功的医院项目，以缩短住院时间、降低剖宫产率和医院死亡率。尽管每个案例研究都反映了一种独特的流程改进方法，但仍观察到几个共同特征：（1）建立由资深医生和护士领导的跨学科流程改进团队；（2）详细审查护理过程，以确定可能影响结果的可修改临床实践；（3）根据小组共识或已发表的建议制定实践指南，旨在影响可修改的实践；（4）积极与个体从业者共享系列数据。
尽管结果数据可以为质量改进工作的目标提供有力见解，但医院必须识别有影响力且可修改的临床实践。如果由跨学科工作组推动，得到资深临床医生和管理人员的支持，并基于当地认可的实践标准，这些努力最有可能取得成功。
