THE VETERANS AFFAIRS CONTINUOUS IMPROVEMENT IN CARDIAC-SURGERY STUDY
THE VETERANS AFFAIRS CONTINUOUS IMPROVEMENT IN CARDIAC-SURGERY STUDY
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DOI：
10.1016/0003-4975(94)91725-6
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发表时间：
1994-12-01
影响因子：
4.6
通讯作者：
HAMMERMEISTER, KE
中科院分区：
文献类型：
--
作者：
GROVER, FL;JOHNSON, RR;HAMMERMEISTER, KE
退伍军人事务部心脏外科顾问委员会负责审查 43 个进行心脏外科手术的退伍军人事务部心脏外科中心的心脏外科治疗质量。它通过审查未调整和风险调整的手术死亡率数据以及围手术期并发症的发生率来做到这一点。这些数据由委员会每半年审查一次，总体摘要和医院特定数据与各个心脏外科项目主任共享。当未经调整和风险调整的手术死亡率增加时，进行纸质审核和现场访问。建设性的批评将与项目主管和医疗中心管理部门分享。许多患者危险因素的相对死亡风险已经被估计，并且现在用于前瞻性临床决策。在采用风险调整结果的 7 年期间，观察到的预期手术死亡率总体上显着下降。尽管许多因素可能导致这一结果，包括不断改进的手术技术，但这种改进也可能部分是由于这些质量改进数据不断反馈给我们的心胸外科医生和心脏病专家而实现的。
The Department of Veterans Affairs Cardiac Surgery Consultants Committee is responsible for reviewing the quality of cardiac surgical treatment at the 43 Veterans Affairs cardiac surgical centers where these procedures are performed. It does so by reviewing both the unadjusted and risk-adjusted operative mortality data and the incidence of perioperative complications. These data are reviewed by the committee semiannually, and the overall summary and hospital-specific data are shared with the individual cardiac surgical program directors. Paper audits and site visits are performed when indicated by increased unadjusted and risk-adjusted operative mortality. Constructive criticism is shared with the program director and medical center administration. The relative risk of death for numerous patient risk factors has been estimated, and is now used in prospective clinical decision making. During the 7-year period that risk-adjusted outcomes have been utilized, there has been an overall significant reduction in the observed-to-expected operative mortality ratio. Although many factors could have contributed to this, including continually improving surgical techniques, it is also likely that part of this improvement has occurred because of the continuous feedback of these quality improvement data to our cardiothoracic surgeons and cardiologists.