HOW A NEW-YORK CARDIAC-SURGERY PROGRAM USES OUTCOMES DATA
HOW A NEW-YORK CARDIAC-SURGERY PROGRAM USES OUTCOMES DATA
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DOI：
10.1016/0003-4975(94)91730-2
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发表时间：
1994-12-01
影响因子：
4.6
通讯作者：
DALCOL, RH
中科院分区：
文献类型：
--
作者：
DZIUBAN, SW;MCILDUFF, JB;DALCOL, RH
在纽约州，自 1989 年 1 月以来，卫生部一直使用风险调整结果系统来监测所有心脏手术。每年都会发布特定于医院和特定医生的结果。在本报告中，我们描述了纽约州一家医院的经验，该医院的结果显示手术死亡率高于预期。工作人员：最初的反应是持怀疑态度的，病例审查没有发现护理质量问题。然而，使用对详细的具体病例结果数据进行统计分析的不同方法更具启发性。死亡率过高主要发生在接受高危紧急冠状动脉旁路移植术的患者，特别是术前不到6小时发生急性心肌梗死的患者、休克患者或血流动力学不稳定的患者。工作人员集中精力优化这些患者的管理，从而在第二年实现了紧急冠状动脉搭桥术的零死亡率。在此过程中，来自所有部门的工作人员以更加协作的方式联合起来执行心脏手术计划。如果可比较的标准和灵活分析的开放获取可用，结果数据对于实现计划改进很有用。
In New York State, a risk-adjusted outcomes system has been used by the Department of Health to monitor all cardiac operations since January 1989. Hospital-specific and physician-specific results are published annually, In this report we describe the experience of one hospital in New York State whose results showed a higher than expected surgical mortality. Staff: reactions were initially skeptical, and case reviews found no quality-of-care problems. However, a different approach using statistical analysis of the detailed case-specific outcomes data was more revealing. The excess mortality was localized to patients having high-acuity, emergency coronary artery bypass grafting, particularly those who had suffered a preoperative acute myocardial infarction less than 6 hours before, those who were in shock, or those who were in a hemodynamically unstable condition. The staff responded with a focused effort to optimize the management of these patients, resulting in zero mortality for emergency coronary artery bypass grafting during the following year. In the process, staff: from all departments joined together in a more collaborative approach to the cardiac surgery program. Outcomes data can be useful for effecting program improvement if comparable norms and open access for flexible analysis are available.