Surgical Quality Improvement: Working Toward Value or a Work in Progress?
Surgical Quality Improvement: Working Toward Value or a Work in Progress?
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DOI：
10.1016/j.jss.2018.09.086
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发表时间：
2019-03-01
影响因子：
2.2
通讯作者：
Massarweh, Nader N.
中科院分区：
文献类型：
--
作者：
Yu, Justin;Massarweh, Nader N.
背景：尽管有许多国家计划旨在确保患者获得高质量的外科护理，但同期的质量改进举措（QII）受到与如何最好地定义“质量”以及确定适当和可操作的质量措施达成普遍共识相关的挑战的限制。材料和方法：使用 Donabedian 概念模型评估医疗保健质量，确定了各个医疗保健级别（即结构、过程和结果）现有外科 QII 的代表性示例，并确定了这些计划的有效性结果：基于手术量的测量是常见的结构质量指标。目前尚不清楚基于数量的 QII（例如“采取数量承诺”和 Leapfrog Group 的循证医院转诊计划）是否会改善手术结果或可能加剧现有的医疗保健差距。专注于护理流程的 QII（例如外科护理改进项目）通常可以有效地提高措施合规性，但无法明显提高护理质量。风险调整后的结果指标仍然是常见的质量指标。但是，缺乏相关的手术特异性结果，并且继续依赖围手术期发病率和死亡率可能无法提供最可靠的手术质量情况。结论：有关现有 QII 有效性的数据表明，可能有重要的机会选择更准确地反映手术护理质量的措施，或加强当前质量指标的测量和报告方式，以更好地捕捉护理点手术服务的复杂动态。由爱思唯尔公司出版
Background: Despite numerous national programs intended to ensure patients receive high-quality surgical care, contemporaneous quality improvement initiatives (QIIs) are limited by the challenges associated with developing universal consensus about how best to define "quality" and the identification of appropriate and actionable quality measures.Materials and methods: Using the Donabedian conceptual model for the evaluation of health care quality, representative examples of existing surgical QIIs at each level of health care (i.e., structure, process, and outcome) were identified, and the effectiveness of these programs was discussed.Results: Surgical volume-based measures are a common structural quality indicator. It remains unclear whether volume-based QIIs, such as "Take the Volume Pledge" and the Leapfrog Group's Evidence-Based Hospital Referral initiative, would improve surgical outcomes or potentially exacerbate existing health care disparities. QIIs focused on processes of care, such as the Surgical Care Improvement Project, are frequently effective at improving measure compliance without clearly improving care quality. Risk-adjusted outcome measures remain common quality indicators. But, relevant procedure-specific outcomes are lacking, and continuing to rely on perioperative morbidity and mortality may not provide the most robust picture of surgical quality.Conclusions: Data regarding the effectiveness of existing QIIs suggest there may be important opportunities to either select measures that more accurately reflect quality surgical care or enhance the manner in which current quality indicators are measured and reported to better capture the complex dynamics of surgical services at the point of care. Published by Elsevier Inc.