Impact of case volume on hospital performance assessment
Impact of case volume on hospital performance assessment
复制标题
DOI：
10.1001/archinte.168.12.1277
复制
发表时间：
2008-06-23
影响因子：
--
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
O'Brien, Sean M.;DeLong, Elizabeth R.;Peterson, Eric D.
背景：过程绩效测量越来越多地用于评估和奖励医院质量。小医院的病例量对这些措施的影响尚不清楚。方法：使用医院质量联盟的数据，我们研究了8个公开报道的急性心肌梗死（AMI）的过程中的措施，从3761美国医院在2005年1月至12月的报告期间的医院性能。对于每个绩效指标，我们检查了医院病例量、流程绩效和“顶级医院”称号之间的关联（性能达到或超过90%百分位数分数）。可用于工艺性能评估的样本量差异很大，范围从每家医院及时给予溶栓治疗的3例患者的中位数到到达时给予阿司匹林的62例患者。医院总的来说，AMI病例量较大的医院有更好的流程绩效;例如，在AMI病例少于10例的医院，72%的患者在到达时使用β受体阻滞剂，而在AMI病例超过100例的医院，80%的患者使用β受体阻滞剂（P
Background: Process performance measures are increasingly used to assess and reward hospital quality. The impact of small hospital case volumes on such measures is not clear.Methods: Using data from the Hospital Quality Alliance, we examined hospital performance for 8 publicly reported process measures for acute myocardial infarction (AMI) from 3761 US hospitals during the reporting period of January to December 2005. For each performance measure, we examined the association between hospital case volume, process performance, and designation as a "top hospital" (performance at or above the 90% percentile score).Results: Sample sizes available for process performance assessment varied considerably, ranging from a median of 3 patients per hospital for timely administration of thrombolytics therapy to 62 patients for aspirin given on arrival at the hospital. In aggregate, hospitals with larger AMI case volumes had better process performance; for example, use of beta-blockers at arrival rose from 72% of patients at hospitals with less than 10 AMI cases to 80% of patients at hospitals with more than 100 cases (P