Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia.
Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia.
复制标题
急诊科的运营变化是为了应对按绩效付费和肺炎抗生素使用时机。
DOI：
10.1197/j.aem.2007.01.022
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
J. Metlay
中科院分区：
文献类型：
--
作者：
J. Pines;J. Hollander;Hoi Lee;W. Everett;L. Uscher;J. Metlay
背景
卫生与公众服务部公开报告了在到达医院后4小时内接受抗生素治疗的肺炎成人患者的百分比，作为质量和绩效付费措施，称为PN-5 b。
目标
确定急诊医学培训项目中的医生领导者对使用PN-5 b作为绩效工资的质量衡量标准的态度，并确定学术急诊部门（ED）为确保肺炎患者的早期抗生素管理而进行的操作变化。
方法
作者对美国135个学术艾德培训项目的129名主席和医疗主任进行了在线问卷调查，内容是对肺炎绩效评估的态度以及学术ED对PN-5 b的反应;每个机构都有一个回应。通过学术急救医学协会网站确定受访者，并通过电子邮件发送五次，以最大限度地提高调查参与度。
结果
90名主席和医务主任（70%）完成了调查; 47%是医务主任，51%是主席，2%是医务主任和主席。45人（50%）不认为PN-5 b是一个准确的质量指标，61人（69%）不认为针对该指标的绩效薪酬会改善肺炎护理。解决PN-5 b的最常见策略是向提供者提供关于早期抗生素治疗重要性的信息（n = 63; 70%）。对于疑似肺炎患者，46（51%）在分诊时自动进行胸部X光片（CXR）排序，37（41%）优先考虑疑似肺炎患者，33（37%）在获得CXR结果之前给予抗生素。总体艾德变化包括改善CXR的周转时间（n = 33; 37%），将CXR优先于其他X线片（n = 13; 14%），以及改善住院床位可用性（n = 12; 13%）。在确定的13种改善PN-5 b的策略中，已实施的方案的中位数为5（四分位数范围，5-7）。所有研究中心均报告至少进行了三次操作变更以解决PN-5 b问题。
结论
本研究中的所有ED都通过多种操作变化解决了早期抗生素给药问题，尽管这些变化将改善护理的观点不一。今后需要进行研究，以衡量按业绩计薪举措的影响。
BACKGROUND
The percentage of adult patients admitted with pneumonia who receive antibiotics within four hours of hospital arrival is publicly reported as a quality and pay-for-performance measure by the Department of Health and Human Services and is called PN-5b.
OBJECTIVES
To determine attitudes among physician leaders at emergency medicine training programs toward using PN-5b as a quality measure for pay for performance, and to determine what operational changes academic emergency departments (EDs) have made to ensure early antibiotic administration for patients with pneumonia.
METHODS
The authors administered an online questionnaire to 129 chairpersons and medical directors of 135 academic ED training programs in the United States on attitudes toward performance measurement in pneumonia and changes that academic EDs have made in response to PN-5b; one response was sought from each institution. Respondents were identified through the Society for Academic Emergency Medicine Web site and e-mailed five times to maximize survey participation.
RESULTS
Ninety chairpersons and medical directors (70%) completed the survey; 47% were medical directors, 51% were chairpersons, and 2% were medical directors and chairpersons. Forty-five (50%) did not agree that PN-5b was an accurate quality measure, and 61 (69%) did not agree that pay for performance targeting this measure would lead to improved pneumonia care. The most common strategy to address PN-5b was to provide information to providers on the importance of early treatment with antibiotics (n = 63; 70%). For patients with suspected pneumonia, 46 (51%) automate chest radiograph (CXR) ordering at triage, 37 (41%) prioritize patients with suspected pneumonia, and 33 (37%) administer antibiotics before obtaining CXR results. Overall ED changes include improved turnaround time for CXR (n = 33; 37%), prioritized CXRs over other radiographs (n = 13; 14%), and improved inpatient bed availability (n = 12; 13%). Of 13 strategies identified to improve PN-5b, the median number that programs have implemented is five (interquartile range, 5-7). All sites reported engaging in at least three operational changes to address PN-5b.
CONCLUSIONS
All EDs in this study have addressed early antibiotic administration with multiple operational changes despite mixed sentiment that these changes will improve care. Future research is needed to measure the impact of pay-for-performance initiatives.
影响因子：
120.7
作者：
Werner, RM;Asch, DA
通讯作者：
Asch, DA