Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.
Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.
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DOI：
10.1371/journal.pone.0141157
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
DUQuE Project Consortium
中科院分区：
文献类型：
--
作者：
Sunol R;Wagner C;Arah OA;Kristensen S;Pfaff H;Klazinga N;Thompson CA;Wang A;DerSarkissian M;Bartels P;Michel P;Groene O;DUQuE Project Consortium
考虑到在医院实施质量计划所投入的时间和资源，很少有研究调查它们的临床影响，以及可以推荐哪些策略来提高其有效性。评估临床实践中的差异，并探索与医院和科室级质量管理体系的联系。多中心、多层次横断面研究。73家急性护理医院，276个科室，管理7个国家的急性心肌梗死、分娩、髋部骨折和中风。没有。预测变量包括3个医院级和4个科室级质量指标。6项测量是通过外部调查员的直接观察收集的，1项是通过医院质量经理填写的问卷进行评估的。因变量包括24个临床实践指标，基于病例记录回顾，涵盖4种情况(急性心肌梗死、分娩、髋部骨折和中风)。有向无环图被用来编码预测因素、结果和协变量之间的关系，并指导控制混杂的协变量的选择。提供了73家医院276个科室9021份临床记录的数据。24项临床实践指标的遵从性有很大差异。医院质量系统与24个指标中的4个之间的相关性较弱，但在分析部门级质量系统时，观察到急性心肌梗死和中风的11个指标中的8个具有较强的相关性。由更高水平的证据支持的临床指标更多地与质量系统和活动有关。在大样本医院中，推荐的护理标准和临床实践之间存在着显著的差距。科室级质量策略的实施与良好的临床实践显著相关。进一步的研究应该着眼于为医院科室制定与临床相关的质量标准，这似乎比普通的医院范围的质量系统更有效。
Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Multicenter, multilevel cross-sectional study. Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. None. Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems.