Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.
Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.
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30 天不良事件的院内变化：对衡量质量的影响。
DOI：
10.1097/jhq.0000000000000086
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Ho,PMichael
中科院分区：
文献类型：
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作者：
Burke,RobertE;Glorioso,Thomas;Barón,AnnaK;Kaboli,PeterJ;Ho,PMichael
需要新的医院质量措施。由于质量改进努力寻求减少过程和结果的变异性，不良事件变异性较高的医院可能提供质量较差的护理。我们试图评估手术后不良事件的院内变异性是否可以作为与设施水平死亡率相关的质量指标。我们分析了2007年至2013年在退伍军人健康管理局（VHA）系统中进行的所有经皮冠状动脉介入治疗（PCI），以评估出院后30天不良事件的院内变异性与（再入院、急诊科就诊和重复血运重建）和机构级死亡率，调整患者人口统计学、合并症、PCI适应症和PCI紧急性后。研究队列包括48家VHA医院的47，567名患者。总体30天不良事件发生率为22.0%，1年死亡率为4.9%。最具可变性的研究中心的30天不良事件发生率在不同阶段之间的相对变化为20%。然而，院内30天内事件的变异性与1年死亡率无关（相关系数= 0.9999）。06; p=. 66）。因此，测量出院后不良事件的院内变异性可能无法改善对低绩效医院的识别。在其他条件下，人口，并与其他质量指标的关系的评价可能会揭示更强的相关性与护理质量。
Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient=. 06; p=. 66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.