Are process performance measures associated with clinical outcomes among patients with hip fractures? A population-based cohort study
Are process performance measures associated with clinical outcomes among patients with hip fractures? A population-based cohort study
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DOI：
10.1093/intqhc/mzw093
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发表时间：
2016-12-01
影响因子：
2.6
通讯作者：
Johnsen, Soren Paaske
中科院分区：
文献类型：
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作者：
Kristensen, Pia Kjaer;Thillemann, Theis Muncholm;Johnsen, Soren Paaske
目的：检查髋部骨折患者的过程表现测量与临床结果之间的关联。设计：全国性、以人群为基础的随访研究。地点：丹麦公立医院。参与者：2010 年至 2013 年间在丹麦因髋部骨折入院的 25 354 名 65 岁或以上患者。干预：过程表现测量，包括系统疼痛评估、早期活动、到达和出院时的基本活动能力评估、出院后康复计划、抗骨质疏松药物和预防未来跌倒事故措施均进行了单独分析，并基于机会的评分定义为个体患者实现的所有相关绩效指标的比例（0-50%、50-75% 和 75-100%）。主要结果指标：30 天死亡率、出院后 30 天再入院率和住院时间 (LOS)。结果：实现 75-100% 的目标相关流程绩效指标与较低的 30 天死亡率（22.6% vs. 8.5%，调整后优势比 (OR) 0.31 (95% CI: 0.28-0.35)）和较低的再入院几率相关（21.7% vs. 17.4%，调整后 OR 0.78 (95% CI: 0.70-0.87)）。护理质量的总体机会评分与 LOS 无关（调整后 OR 1.00 (95% CI: 0.98-1.04)）。术后 24 小时内活动是与较低 30 天死亡率、再入院风险和较短 LOS 相关性最强的过程。 结论：对于髋部骨折患者，较高质量的院内护理，特别是早期活动与更好的临床结果相关，包括较低的 30 天死亡率。
Objectives: To examine the association between process performance measures and clinical outcome among patients with hip fracture.Design: Nationwide, population-based follow-up study.Setting: Public Danish hospitals.Participants: A total of 25 354 patients 65 years or older who were admitted with a hip fracture in Denmark between 2010 and 2013.Intervention: The process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment at arrival and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future fall accidents measures, were analysed individually as well as an opportunity-based score defined as the proportion of all relevant performance measures fulfilled for the individual patient (0-50%, 50-75% and 75-100%).Main Outcome Measures: Thirty-day mortality, 30-day readmission after discharge and length of stay (LOS).Results: Fulfilling 75-100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) 0.31 (95% CI: 0.28-0.35)) and lower odds for readmission (21.7% vs. 17.4%, adjusted OR 0.78 (95% CI: 0.70-0.87)). The overall opportunity score for quality of care was not associated with LOS (adjusted OR 1.00 (95% CI: 0.98-1.04)). Mobilization within 24 h postoperatively was the process with the strongest association with lower 30-day mortality, readmission risk and shorter LOS.Conclusions: Higher quality of in-hospital care and in particular early mobilization was associated with a better clinical outcome, including lower 30-day mortality, among patients with hip fracture.