A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery
A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery
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DOI：
10.1001/jama.275.11.841
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发表时间：
1996-03-20
影响因子：
120.7
通讯作者：
Kasper, JF
中科院分区：
文献类型：
--
作者：
OConnor, GT;Plume, SK;Kasper, JF
客观。-为了确定是否有组织的干预，包括数据反馈，持续质量改进技术的培训，以及对其他医疗中心的现场访问可以改善与冠状动脉旁路移植术（CABG）手术相关的医院死亡率。区域干预研究。收集1987年7月1日至1993年7月31日期间北方新英格兰CABG患者的人口统计学和历史数据、体表面积、心导管检查结果、手术优先级、合并症和出院时的状态。这项研究包括了研究期间在缅因州、新罕布什尔州和佛蒙特州执业的所有23名心胸外科医生。在研究期间，收集了在缅因州、新罕布什尔州和佛蒙特州接受隔离CABG手术的15095名连续患者的数据。1990年和1991年进行了旨在降低CABG死亡率的三部分干预。干预措施包括结果数据的反馈，持续质量改进技术的培训，以及对其他医疗中心的现场访问。在干预后期间观察到的和预期的住院死亡率的比较。在干预后期间，我们观察了6488例连续CABG手术的结局，死亡人数比预期少74人。住院死亡率降低24%具有统计学意义（P= 0.001）。这种死亡率的降低在患者亚组中相对一致，并且与干预措施在时间上相关。我们的结论是，一个多机构，区域模式，不断提高外科护理是可行的和有效的。这种模式可能在其他环境中也有应用。
Objective.-To determine whether an organized intervention including data feedback, training in continuous quality improvement techniques, and site visits to other medical centers could improve the hospital mortality rates associated with coronary artery bypass graft (CABG) surgery.Design.-Regional intervention study. Patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected on CABG patients in Northern New England between July 1, 1987, and July 31, 1993.Setting.-This study included all 23 cardiothoracic surgeons practicing in Maine, New Hampshire, and Vermont during the study period.Patients.-Data were collected on 15 095 consecutive patients undergoing isolated CABG procedures in Maine, New Hampshire, and Vermont during the study period.Interventions.-A three-component intervention aimed at reducing CABG mortality was fielded in 1990 and 1991. The interventions included feedback of outcome data, training in continuous quality improvement techniques, and site visits to other medical centers.Main Outcome Measure.-A comparison of the observed and expected hospital mortality rates during the postintervention period.Results.-During the postintervention period, we observed the outcomes for 6488 consecutive cases of CABG surgery, There were 74 fewer deaths than would have been expected. This 24% reduction in the hospital mortality rate was statistically significant (P=.001). This reduction in mortality rate was relatively consistent across patient subgroups and was temporally associated with the interventions.Conclusion.-We conclude that a multi-institutional, regional model for the continuous improvement of surgical care is feasible and effective. This model may have applications in other settings.