Indirect vs direct hospital quality indicators for very low-birth-weight infants
Indirect vs direct hospital quality indicators for very low-birth-weight infants
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DOI：
10.1001/jama.291.2.202
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发表时间：
2004-01-14
影响因子：
120.7
通讯作者：
Geppert, J
中科院分区：
文献类型：
--
作者：
Rogowski, JA;Horbar, JD;Geppert, J
越来越多的保险公司正在使用基于证据的选择性转诊策略，以确保由高质量的提供者提供医疗服务。在缺乏直接质量措施的基础上，病人的结果，目前的标准，许多条件依赖于间接质量措施，如patient volume.Objectives评估潜在的有用性的体积作为一个质量指标，为极低出生体重（VLBW）婴儿和比较体积与其他潜在指标的基础上，现成的医院特点和病人的结果。研究对象：回顾性研究1995年1月1日至2000年12月31日在332家设有新生儿重症监护病房的佛蒙特牛津网络医院出生的94110名体重501 - 1500 g的VLBW婴儿。主要结果：详细的病例组合调整是通过使用出生后立即可用的患者特征来进行的。结果在每年收治VLBW婴儿少于50例的医院中，额外的10例入院与死亡率降低11%相关（95%置信区间[CI]，5%-16%; P
Context Evidence-based selective referral strategies are being used by an increasing number of insurers to ensure that medical care is provided by high-quality providers. In the absence of direct-quality measures based on patient outcomes, the standards currently in place for many conditions rely on indirect-quality measures such as patient volume.Objectives To assess the potential usefulness of volume as a quality indicator for very low-birth-weight (VLBW) infants and compare volume with other potential indicators based on readily available hospital characteristics and patient outcomes.Design, Setting, and Participants A retrospective study of 94110 VLBW infants weighing 501 to 1500 g born in 332 Vermont Oxford Network hospitals with neonatal intensive care units between January 1, 1995, and December 31, 2000.Main Outcome Measures Mortality among VLBW infants prior to discharge home; detailed case-mix adjustment was performed by using patient characteristics available immediately after birth.Results In hospitals with less than 50 annual admissions of VLBW infants, an additional 10 admissions were associated with an 11% reduction in mortality (95% confidence interval [CI], 5%-16%; P