The Adverse Outcome Index Putting Quality Into an Outcome Measure
The Adverse Outcome Index Putting Quality Into an Outcome Measure
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DOI：
10.1097/aog.0000000000002791
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发表时间：
2018-09-01
影响因子：
7.2
通讯作者：
Minkoff, Howard
中科院分区：
文献类型：
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作者：
Atallah, Fouad;Bernstein, Peter S.;Minkoff, Howard
不良结果指数最初旨在提供一个客观的不良结果清单，现在经常被推广为评估住院产科护理质量的工具。尽管不良结果指数描述得很好，其结果也很容易收集，但它有明显的缺点，如“矛盾的措施”（例如，输血即使使用得当也被算作不良措施），以及在不良结果指数中占主导地位的某些措施可以推动得分（例如，新生儿重症监护病房入院）。在这篇文章中，我们认为，除了指出的局限性，不良结果指数，虽然提供了一个合理的衡量住院产科视力，未能成为一个可靠的衡量质量。这一点尤其重要，因为许多组织都在寻求质量指标，而不良结果指数可能成为候选工具。我们认为，为不利结果指数引入一个裁决程序，将大大加强其作为质量指标的作用。在新提出的质量措施得到完善和采用之前，质量调整不良结果指数将允许这一广泛使用的措施提供更可靠的不良事件的确定，这些不良事件可能需要改进性能。
The Adverse Outcome Index, originally designed to provide an objective inventory of adverse outcomes, is often promoted as a tool for assessing the quality of inpatient obstetric care. Although the Adverse Outcome Index is well described, and its outcomes are easy to collect, it has notable drawbacks such as "paradoxical measures" (eg, blood transfusions are counted as adverse measures even when they are used appropriately) and the dominance of certain measures within the Adverse Outcome Index that can drive scores (eg, neonatal intensive care unit admissions). In this article, we argue that in addition to the limitations noted, the Adverse Outcome Index, although providing a reasonable measure of inpatient obstetric acuity, fails to be a reliable measure of quality. This is particularly important because many organizations are seeking quality measures and the Adverse Outcome Index may become a candidate tool. We believe that introducing an adjudication process to the Adverse Outcome Index would greatly enhance its role as a quality indicator. Until newly proposed quality measures are perfected and adopted, a quality-adjusted Adverse Outcome Index will allow this widely used measure to provide a more reliable determination of those adverse events potentially amenable to performance improvement.