Relationships Between Pediatric Safety Indicators Across a National Sample of Pediatric Hospitals: Dispelling the Myth of the "Safest" Hospital.
Relationships Between Pediatric Safety Indicators Across a National Sample of Pediatric Hospitals: Dispelling the Myth of the "Safest" Hospital.
复制标题
全国儿科医院样本中儿科安全指标之间的关系：消除“最安全”医院的神话。
DOI：
10.1097/pts.0000000000000938
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发表时间：
2022
影响因子：
2.2
通讯作者：
Ozonoff,Al
中科院分区：
文献类型：
--
作者：
Milliren,CarlyE;Bailey,George;Graham,DionneA;Ozonoff,Al
有许多医疗质量的衡量标准，但没有明显的总结措施，以简化医院绩效的排名。随着医院绩效的公开报告和问责制，绩效排名的综合措施的有效性越来越重要。本研究旨在探讨儿科医院质量指标的协方差，并评估使用一个单一的复合scores.MethodsWe进行了一项观察性研究，儿科医院的性能在13个安全指标提取的儿科健康信息系统，比较数据库的儿童医院在美国。我们纳入了2016年1月1日至2019年12月31日从36家医院出院的患者。使用主成分分析，我们调查了医疗保健研究和质量机构儿科质量指标和医疗保险和医疗补助服务中心医院获得性条件的患者安全措施之间的关系。我们比较和总结排名的基础上，个人的安全指标和计算替代复合scores.ResultsWe确定了5个正交方差分量占68%的变化，儿科医院的质量指标。与医院间变化相比，排名显示出更大的医院内变化。我们观察到不一致的排名在常用的汇总措施，并得出结论，这些儿科安全措施证明至少有2个潜在的方差components.ConclusionsThis研究表明，患者的安全性的多因素的性质。这意味着没有根据这些措施对医院进行独特的排序，因此，没有一家儿科医院可以声称是“最安全的”。这就进一步提出了关于按安全性对医院进行排名的适当方法的问题。
ObjectiveThere are many measures of healthcare quality, but no obvious summary measures to simplify ranking of hospital performance. With public reporting and accountability for hospital performance, the validity of composite measures for performance rankings has increased importance. This study aimed to explore the covariance of pediatric hospital quality indicators and evaluate the use of a single composite score.MethodsWe performed an observational study of pediatric hospital performance across 13 safety indicators extracted from the Pediatric Health Information System, a comparative database of children’s hospitals in the United States. We included patients discharged from 36 hospitals from January 1, 2016, to December 31, 2019. Using principal components analysis, we investigate relationships among patient safety measures from the Agency for Healthcare Research and Quality pediatric quality indicators and Center for Medicare and Medicaid Services hospital-acquired conditions. We compare and summarize rankings based on individual safety indicators and calculate alternative composite scores.ResultsWe identified 5 orthogonal variance components accounting for 68% of variation in pediatric hospital quality indicators. Rankings demonstrated greater within-hospital variation compared with between-hospital variation. We observed discordant rankings across commonly used summary measures and conclude that these pediatric safety measures demonstrate at least 2 underlying variance components.ConclusionsThis study demonstrates the multifactorial nature of patient safety. This implies no unique ordering of hospitals based on these measures, and thus, no pediatric hospital can claim to be “the safest.” This raises further questions about appropriate methods to rank hospitals by safety.