Care in US hospitals - The Hospital Quality Alliance Program.
Care in US hospitals - The Hospital Quality Alliance Program.
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DOI：
10.1056/nejmsa051249
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发表时间：
2005-07-21
影响因子：
158.5
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Jha, AK;Li, ZH;Epstein, AM
背景：医院质量联盟 (HQA) 是第一个定期报告全国医院绩效数据的倡议。迄今为止，此类数据尚未获得。方法：我们使用了医疗保险和医疗补助服务中心收集的关于急性心肌梗死、充血性心力衰竭和肺炎护理质量的 10 项指标的数据。主要结果指标是医院在每项指标方面的表现以及每种临床状况的总结分数。使用多元线性回归确定高水平绩效的预测因素。结果：2004 年上半年，共有 3558 家医院报告了至少一项稳定指标的数据（定义为从至少 25 名患者的出院数据中获得的信息）。10 项指标中的 5 项绩效得分中位数（表示为满足标准的患者百分比）至少为 90%，但其他 5 项指标较低。 大型医院转诊地区，排名靠前的地区得分（急性心肌梗死）比排名靠后的地区高出 12 个百分点至 23 个百分点（肺炎）。对急性心肌梗塞的高质量护理可以预测对充血性心力衰竭的高质量护理，但仅比预测对肺炎的高质量护理的机会稍好一些。与绩效小幅但显着增长相关的特征包括学术医院、东北或中西部医院以及非营利医院。结论：对新 HQA 国家报告系统数据的分析表明，医院之间和指标之间的绩效存在差异。鉴于这种变化以及基于医院特征的微小差异，绩效报告可能需要包括来自广泛医院的大量临床情况。
Background: The Hospital Quality Alliance (HQA) is the first initiative that routinely reports data on hospitals' performance nationally. Heretofore, such data have been unavailable.Methods: We used data collected by the Centers for Medicare and Medicaid Services on 10 indicators of the quality of care for acute myocardial infarction, congestive heart failure, and pneumonia. The main outcome measures were hospitals' performance with respect to each indicator and summary scores for each clinical condition. Predictors of a high level of performance were determined with the use of multivariable linear regression.Results: A total of 3558 hospitals reported data on at least one stable measure (defined as information obtained from discharge data from at least 25 patients) during the first half of 2004. Median performance scores (expressed as the percentage of patients who satisfied the criterion) were at least 90 percent for 5 of the 10 measures but lower for the other 5. Performance varied moderately among large hospital-referral regions, with the top-ranked regions scoring 12 percentage points (for acute myocardial infarction) to 23 percentage points (for pneumonia) higher than the bottom-ranked regions. A high quality of care for acute myocardial infarction predicted a high quality of care for congestive heart failure but was only marginally better than chance at predicting a high quality of care for pneumonia. Characteristics associated with small but significant increases in performance included being an academic hospital, being in the Northeast or Midwest, and being a not-for-profit hospital.Conclusions: Analysis of data from the new HQA national reporting system shows that performance varies among hospitals and across indicators. Given this variation and small differences based on hospitals' characteristics, performance reporting will probably need to include numerous clinical conditions from a broad range of hospitals.