Young G J, Charns M P, Desai K, Khuri S F, Forbes M G, Henderson W, Daley J
Boston University School of Public Health, USA.
Health Serv Res. 1998 Dec;33(5 Pt 1):1211-36.
To test the hypothesis that surgical services combining relatively high levels of feedback and programming approaches to the coordination of surgical staff would have better quality of care than surgical services using low levels of both coordination approaches as well as those surgical service using low levels of either coordination approach.
A study sample of 44 academically affiliated surgical services that are part of the Department of Veterans Affairs.
In a cross-sectional analysis, surgical services were assigned to one of three groups based on their scores on feedback and programming coordination measures: high on both measures; high on one measure, low on the other; and low on both. Univariate and multivariate analyses were used to assess differences among these groups with respect to three quality indicators: risk-adjusted mortality, risk-adjusted morbidity, and staff perceptions of quality.
DATA COLLECTION/EXTRACTION METHODS: Risk-adjusted mortality and morbidity came from an outcomes reporting program within the Department of Veterans Affairs that entails the prospective collection of clinical data from patient charts. Data on coordination practices and perceived quality came from a survey of surgical staff at each of the 44 participating surgical services.
The group of surgical services using high feedback and high programming had the best perceived quality. This group also had the lowest morbidity, but the difference was statistically significant with respect to only one of the two other groups: the group with low feedback and low programming. No significant group differences were found for mortality.
Study results provide partial support for the hypothesis that high levels of feedback and programming should be combined for optimal quality of care. Study results also suggest that staff coordination is more important for improving morbidity than mortality in surgical services.
检验以下假设，即结合相对高水平反馈和规划方法来协调手术人员的手术服务，其医疗质量要优于采用低水平协调方法的手术服务以及仅采用低水平其中一种协调方法的手术服务。
从退伍军人事务部选取44个学术附属手术服务作为研究样本。
在横断面分析中，根据手术服务在反馈和规划协调措施方面的得分，将其分为三组之一：两项措施得分均高；一项措施得分高，另一项措施得分低；两项措施得分均低。使用单变量和多变量分析来评估这些组在三个质量指标方面的差异：风险调整后的死亡率、风险调整后的发病率以及工作人员对质量的看法。
数据收集/提取方法：风险调整后的死亡率和发病率来自退伍军人事务部的一个结果报告项目，该项目需要从患者病历中前瞻性收集临床数据。关于协调实践和感知质量的数据来自对44个参与手术服务机构的手术人员的调查。
采用高反馈和高规划的手术服务组的感知质量最佳。该组的发病率也最低，但仅在与另外两组中的一组（低反馈和低规划组）相比时，差异具有统计学意义。在死亡率方面未发现显著的组间差异。
研究结果为以下假设提供了部分支持，即应结合高水平的反馈和规划以实现最佳医疗质量。研究结果还表明，在手术服务中，工作人员协调对于降低发病率比降低死亡率更为重要。
