Discharge Documentation of Patients Discharged to Subacute Facilities: A Three-Year Quality Improvement Process Across an Integrated Health Care System
Discharge Documentation of Patients Discharged to Subacute Facilities: A Three-Year Quality Improvement Process Across an Integrated Health Care System
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DOI：
10.1016/s1553-7250(10)36039-9
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发表时间：
2010-06-01
影响因子：
2.3
通讯作者：
Schnipper, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Gandara, Esteban;Ungar, Jonathan;Schnipper, Jeffrey L.
背景：出院期间医师之间的有效沟通对患者护理至关重要。合作伙伴医疗保健（波士顿）参与了一项多年的进程，以衡量和改善从其五家急症护理医院转到亚急症设施的所有患者的文件质量。方法：合作伙伴首先与利益相关者合作，为所有亚急性设施的排放制定一套共识的12个所需数据元素。建立了一个测量过程，后来又进行了改进。随后启动了质量改进干预措施，以解决已测量到的缺陷，包括对医生和护士进行教育、改进信息技术、创建或改进出院文件模板、培训医院医生作为榜样、向医生及其服务主管提供关于审查病例的反馈以及病例管理员在出院前审查文件。为了度量由于这些努力而产生的质量改进，随着时间的推移分析了同时包含所有12个适用数据元素的比率（“无缺陷率”）。结果：对2006年1月1日至2008年9月期间在亚急性医疗机构出院的3101例患者的出院文件包进行回顾性研究。在监测的11个季度中，无缺陷率从65%增加到96% (p
Background: Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities.Methods: Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time.Results: Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p