Perioperative patient safety indicators and hospital surgical volumes.
Perioperative patient safety indicators and hospital surgical volumes.
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DOI：
10.1186/1756-0500-7-117
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发表时间：
2014-02-28
影响因子：
1.8
通讯作者：
Hasegawa T
中科院分区：
文献类型：
--
作者：
Kitazawa T;Matsumoto K;Fujita S;Yoshida A;Iida S;Nishizawa H;Hasegawa T
自20世纪90年代末以来，患者安全一直是发达国家的一个重要政策问题。为了评估患者安全活动的有效性，有必要使用有形数据根据失败模式的类型来定量评估不良事件的发生率。本研究的目的是使用日本诊断程序组合/按日付费系统(DPC/PDPS)的报销数据计算患者安全指标(PSI)，并阐明围手术期PSI与医院手术量的关系。使用全日本医院协会管理的Medi-Target项目的DPC/PDPS数据。进行了一项观察性研究，其中使用美国卫生保健研究和质量机构提出的算法计算PSI。我们分析了188家医院从2008年1月到2010年12月出院的1,383,872名患者的数据。在20个提供者层面的PSI中，有4个PSI(3个围手术期PSI和压疮)和术后患者的死亡率与手术量有关。病死率(5.7%，95%可信区间，3.9%~7.4%)高于中等医院(2.9%，95%可信区间，2.6%~3.3%)和大容量医院(2.7%，95%可信区间，2.5%~2.9%)。在有严重并发症的外科住院患者中，低流量医院的死亡率(38.5%，95%CI，33.7%至43.2%)高于大流量医院(21.4%，95%CI，19.0%至23.9%)。与大容量医院(63.4%，95%CI，62.3%~64.6%)相比，小容量医院的困难手术比例(54.9%，95%CI，50.1%~59.8%)更低。在低流量医院，有限的经验可能导致对术后并发症的护理不足。我们证明了PSI可以使用DPC/PDPS数据来计算，并且围手术期PSI与医院手术量有关。需要进行进一步的调查，重点是找出不良PSI的风险因素，并向这些医院提供有效支持。
Since the late 1990s, patient safety has been an important policy issue in developed countries. To evaluate the effectiveness of the activities of patient safety, it is necessary to quantitatively assess the incidence of adverse events by types of failure mode using tangible data. The purpose of this study is to calculate patient safety indicators (PSIs) using the Japanese Diagnosis Procedure Combination/per-diem payment system (DPC/PDPS) reimbursement data and to elucidate the relationship between perioperative PSIs and hospital surgical volume. DPC/PDPS data of the Medi-Target project managed by the All Japan Hospital Association were used. An observational study was conducted where PSIs were calculated using an algorithm proposed by the US Agency for Healthcare Research and Quality. We analyzed data of 1,383,872 patients from 188 hospitals who were discharged from January 2008 to December 2010. Among 20 provider level PSIs, four PSIs (three perioperative PSIs and decubitus ulcer) and mortality rates of postoperative patients were related to surgical volume. Low-volume hospitals (less than 33rd percentiles surgical volume per month) had higher mortality rates (5.7%, 95% confidence interval (CI), 3.9% to 7.4%) than mid- (2.9%, 95% CI, 2.6% to 3.3%) or high-volume hospitals (2.7%, 95% CI, 2.5% to 2.9%). Low-volume hospitals had more deaths among surgical inpatients with serious treatable complications (38.5%, 95% CI, 33.7% to 43.2%) than high-volume hospitals (21.4%, 95% CI, 19.0% to 23.9%). Also Low-volume hospitals had lower proportion of difficult surgeries (54.9%, 95% CI, 50.1% to 59.8%) compared with high-volume hospitals (63.4%, 95% CI, 62.3% to 64.6%). In low-volume hospitals, limited experience may have led to insufficient care for postoperative complications. We demonstrated that PSIs can be calculated using DPC/PDPS data and perioperative PSIs were related to hospital surgical volume. Further investigations focusing on identifying risk factors for poor PSIs and effective support to these hospitals are needed.