Quality improvement in cardiovascular surgery: results of a surgical quality improvement programme using a nationwide clinical database and database-driven site visits in Japan
Quality improvement in cardiovascular surgery: results of a surgical quality improvement programme using a nationwide clinical database and database-driven site visits in Japan
复制标题
DOI：
10.1136/bmjqs-2019-009955
复制
发表时间：
2020-07-01
影响因子：
5.4
通讯作者：
Takamoto, Shinichi
中科院分区：
文献类型：
--
作者：
Yamamoto, Hiroyuki;Miyata, Hiroaki;Takamoto, Shinichi
背景
2015年，日本启动了一项由学术机构主导的外科质量改进（QI）项目，利用2013年至2014年录入的数据库信息来确定需要改进的机构，并派心血管外科专家前往这些机构进行实地考察。在此，采用事后分析来评估该QI项目在降低手术死亡率（30天死亡率和住院死亡率）方面的有效性。
方法
从日本心血管外科数据库中选取患者，如果他们在2013年至2016年期间接受了单纯冠状动脉旁路移植术（CABG）、瓣膜手术或胸主动脉手术。该数据库几乎涵盖了日本所有的心血管手术。在对患者层面的预期手术死亡率进行调整后，采用基于广义估计方程逻辑回归模型的双重差分法进行前后比较。
结果
2013年1月至2016年12月期间，共纳入来自590家医院的238778名患者（10172例死亡），其中包括在10家接受实地考察的医院就诊的3556名患者。在项目实施前，接受实地考察和未接受实地考察的机构的CABG手术粗手术死亡率分别为9.0%和2.7%，瓣膜手术分别为10.7%和4.0%，主动脉手术分别为20.7%和7.5%。项目实施后，在接受实地考察的医院观察到适度改善（分别为3.6%、9.6%和18.8%）。双重差分估计量显示CABG手术有显著改善（0.29（95%置信区间0.15 - 0.54），p
（最后一个单词“p”后面似乎内容不完整，如果还有遗漏信息，请告诉我，以便我更好地为你服务。）
Background In 2015, an academic-led surgical quality improvement (QI) programme was initiated in Japan to use database information entered from 2013 to 2014 to identify institutions needing improvement, to which cardiovascular surgery experts were sent for site visits. Here, posthoc analyses were used to estimate the effectiveness of the QI programme in reducing surgical mortality (30-day and in-hospital mortality). Methods Patients were selected from the Japan Cardiovascular Surgery Database, which includes almost all cardiovascular surgeries in Japan, if they underwent isolated coronary artery bypass graft (CABG), valve or thoracic aortic surgery from 2013 to 2016. Difference-in-difference methods based on a generalised estimating equation logistic regression model were used for pre-post comparison after adjustment for patient-level expected surgical mortality. Results In total, 238 778 patients (10 172 deaths) from 590 hospitals, including 3556 patients seen at 10 hospitals with site visits, were included from January 2013 to December 2016. Preprogramme, the crude surgical mortality for site visit and non-site visit institutions was 9.0% and 2.7%, respectively, for CABG surgery, 10.7% and 4.0%, respectively, for valve surgery and 20.7% and 7.5%, respectively, for aortic surgery. Postprogramme, moderate improvement was observed at site visit hospitals (3.6%, 9.6% and 18.8%, respectively). A difference-in-difference estimator showed significant improvement in CABG (0.29 (95% CI 0.15 to 0.54), p