Validating risk-adjusted surgical outcomes: Site visit assessment of process and structure
Validating risk-adjusted surgical outcomes: Site visit assessment of process and structure
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DOI：
10.1016/s1072-7515(01)00940-1
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发表时间：
1997-10-01
影响因子：
5.2
通讯作者：
Khuri, SF
中科院分区：
文献类型：
--
作者：
Daley, J;Forbes, MG;Khuri, SF
背景：风险调整后的死亡率和发病率通常被用作外科护理质量的衡量标准。这项研究旨在通过评估风险调整后30天死亡率和发病率高于预期和低于预期的外科服务的护理过程和结构，来确定风险调整后的手术发病率和死亡率作为护理质量指标的有效性。研究设计：对44个退伍军人医疗中心外科服务进行结构性调查，并对20个风险调整后结果高于预期和低于预期的外科服务进行实地访问，主要结果指标包括评估技术和设备、工作人员的技术能力、领导力、与其他服务的关系、护理质量监测、工作协调、与附属机构的关系和整体护理质量，结果：外科重症监护病房中风险调整后的手术发病率和死亡率低于预期的外科服务比结果高于预期的服务有更多的设备可用(4.3比2.9，p<；对于发病率和死亡率低于预期的外科服务，现场访问者对总体护理质量的评分显著高于预期(6.1vs4.5，高离群值，p<；0.001)；在低离群值服务中，技术和设备的评分明显更高(7.1vs4.8，p<；0.001)。蒙面现场访问团队正确地预测了所访问的20个外科服务中的17个(P<；0.001)的离群值状态(高与低)。结论：提供手术护理的过程和结构的多个维度的显著差异与44个退伍军人事务医疗中心之间风险调整后的手术发病率和死亡率的差异有关。(C)1997年由美国外科医师学会颁发。
Background: Risk-adjusted mortality and morbidity rates are often used as measures of the quality of surgical care. This study was conducted to determine the validity of risk-adjusted surgical morbidity and mortality rates as measures of quality of care by assessing the process and structure of care in surgical services with higher-than-expected and lower-than-expected risk-adjusted 30-day mortality and morbidity rates,Study Design: A structural survey of 44 Veterans Affairs Medical Center surgical services and site visits to 20 surgical services with higher-than-expected and lower-than-expected risk-adjusted outcomes were conducted, Main outcome measures included assessment of technology and equipment, technical competence of staff, leadership, relationship with other services, monitoring of quality of care, coordination of work, relationship with affiliated institutions, and overall quality of care,Results: Surgical services with lower-than-expected risk-adjusted surgical morbidity and mortality rates had significantly more equipment available in surgical intensive care units than did services with higher-than-expected outcomes (4.3 versus 2.9, p < 0.05), Site-visitor ratings of overall quality of care were significantly higher for surgical services with lower-than-expected morbidity and mortality rates (6.1 versus 4.5 for high outliers, p < 0.05); technology and equipment were rated significantly better among low-outlier services (7.1 versus 4.8 for high outliers, p < 0.001). Masked site-visit teams correctly predicted the outlier status (high versus low) of 17 of the 20 surgical services visited (p < 0.001).Conclusions: Significant differences in several dimensions of process and structure of the delivery of surgical care are associated with differences in risk-adjusted surgical morbidity and mortality rates among 44 Veterans Affairs Medical Centers. (C) 1997 by the American College of Surgeons.