IMPACT OF QUALITY-OF-CARE FACTORS ON PEDIATRIC INTENSIVE-CARE UNIT MORTALITY
IMPACT OF QUALITY-OF-CARE FACTORS ON PEDIATRIC INTENSIVE-CARE UNIT MORTALITY
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DOI：
10.1001/jama.272.12.941
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发表时间：
1994-09-28
影响因子：
120.7
通讯作者：
LEVETOWN, M
中科院分区：
文献类型：
--
作者：
POLLACK, MM;CUERDON, TT;LEVETOWN, M
客观。-确定以下护理因素的重要性，这些因素以前与医院质量对儿科重症监护的生存率相关：重症监护病房（ICU）的大小，ICU所在医院的医学院教学状况，专家地位（儿科重症监护医师）和单位协调。在全国调查后，在随机选择的16个地点收集了连续的病例系列，以代表护理质量因素的独特组合。儿科ICU.患者. -每个研究中心的连续入院率。主要结果测量。根据生理状态、诊断和其他死亡风险因素调整患者死亡率。有5415名儿科ICU入院，248名ICU死亡。ICU在描述性变量方面存在显著差异，包括死亡率（范围，2.2%至16.4%）。风险调整死亡率的分析表明，医院的教学状况和儿科重症监护医师的存在与患者的生存机会显着相关。在教学医院的ICU住院后，患者的生存概率降低（相对死亡几率，1.79; 95%置信区间[CI]，1.23至2.61; P= 0.002）。相比之下，在儿科重症监护医生的监护下，患者在ICU住院后的生存概率有所提高（相对死亡几率，0.65; 95%CI，0.44 - 0.95; P= 0.027）。事后分析表明，教学医院的严重程度调整后的死亡率较高，这可能是由于住院医生照顾ICU患者的存在。表征最佳整体医院质量的特征可能与专业护理领域（包括儿科ICU）的护理质量无关，或可能呈负相关。
Objective.-To determine the importance of the following care factors previously associated with hospital quality on survival from pediatric intensive care: size of the intensive care unit (ICU), medical school teaching status of the hospital housing the ICU, specialist status (pediatric intensivist), and unit coordination.Design.-After a national survey, consecutive case series were collected at 16 sites randomly selected to represent unique combinations of quality-of-care factors.Setting.-Pediatric ICUs.Patients.-Consecutive admissions to each site.Main Outcome Measure.-Patient mortality adjusted for physiologic status, diagnosis, and other mortality risk factors.Results.-There were 5415 pediatric ICU admissions and 248 ICU deaths. The ICUs differed significantly with respect to descriptive variables, including mortality (range, 2.2% to 16.4%). Analysis of risk-adjusted mortality indicated that the hospital teaching status and the presence of a pediatric intensivist were significantly associated with a patient's chance of survival. The probability of patient survival after hospitalization in an ICU located in a teaching hospital was decreased (relative odds of dying, 1.79; 95% confidence interval [CI], 1.23 to 2.61; P=.002). In contrast, the probability of patient survival after hospitalization in an ICU with a pediatric intensivist was improved (relative odds of dying, 0.65; 95% CI, 0.44 to 0.95; P=.027). Post hoc analysis indicated that the higher severity-adjusted mortality in teaching hospitals may be explained by the presence of residents caring for ICU patients.Conclusion.-Characteristics indicative of the best overall hospital quality may not be associated, or may be negatively associated, with quality of care in specialized care areas, including the pediatric ICU.