Missed opportunities in TB diagnosis: a TB process-based performance review tool to evaluate and improve clinical care.
Missed opportunities in TB diagnosis: a TB process-based performance review tool to evaluate and improve clinical care.
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DOI：
10.1186/1471-2458-11-127
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发表时间：
2011-02-22
影响因子：
4.5
通讯作者：
Sonnenberg P
中科院分区：
文献类型：
--
作者：
Field N;Murray J;Wong ML;Dowdeswell R;Dudumayo N;Rametsi L;Martinson N;Lipman M;Glynn JR;Sonnenberg P
传统的结核病（TB）治疗结果指标，如治愈率，不能深入了解缺少临床靶点的根本原因。我们评估了结核病基于流程的绩效评估（TB- pbpr）工具，该工具的开发是为了识别及时准确诊断结核病的“错失机会”。该工具能够在过程和护理质量水平上进行绩效评估。结核病- pbpr工具是一份单页的结构化流程图，可确定14项临床行动（分为诱发症状、临床检查和调查）。在两家南非矿山医院（A = 56例；B = 26例）、一家南非教学医院（C = 20例）和一家联合王国教学医院（D = 13例）审查了选定的死亡患者的医疗记录。在常规尸检的A医院，52%（23/44）的病例在生活中遗漏了结核病，16%（18/110）的病例被错误地归因于死亡原因。在每个医院和临床管理的每个阶段确定临床遗漏。例如，高达39%的病例没有记录胸部症状，高达85%的病例没有进行痰涂片检查，高达38%的病例没有进行胸片检查。本研究介绍了TB- pbpr工具作为一种新的方法来审查和评估结核病管理的临床表现。我们发现，在许多情况下，简单的临床行动被忽略了。该工具与描述最佳做法的手册一起适用于一系列环境，具有教育意义，并能够在结核病规划中提供详细反馈。TB-PBPR工具和手册都是免费的，可供一般使用。
Traditional tuberculosis (TB) treatment outcome measures, such as cure rate, do not provide insight into the underlying reasons for missing clinical targets. We evaluated a TB Process-Based Performance Review (TB-PBPR) tool, developed to identify "missed opportunities" for timely and accurate diagnosis of TB. The tool enables performance assessment at the level of process and quality of care. The TB-PBPR tool is a single-page structured flow-sheet that identifies 14 clinical actions (grouped into elicited symptoms, clinical examination and investigations). Medical records from selected deceased patients were reviewed at two South African mine hospitals (A = 56 cases; B = 26 cases), a South African teaching hospital (C = 20 cases) and a UK teaching hospital (D = 13 cases). In hospital A, where autopsy was routine, TB was missed in life in 52% (23/44) of cases and was wrongly attributed as the cause of death in 16% (18/110). Clinical omissions were identified at each hospital and at every stage of clinical management. For example, recording of chest symptoms was omitted in up to 39% of cases, sputum smear examination in up to 85% and chest radiograph in up to 38% of cases respectively. This study introduces the TB-PBPR tool as a novel method to review and evaluate clinical performance in TB management. We found that simple clinical actions were omitted in many cases. The tool, in conjunction with a manual describing best practice, is adaptable to a range of settings, is educational and enables detailed feedback within a TB programme. The TB-PBPR tool and manual are both freely available for general use.
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影响因子：
3.8
作者：
Murray, Jill;Sonnenberg, Pam;Glynn, Judith R.
通讯作者：
Glynn, Judith R.
影响因子：
3.8
作者：
Martinson, Neil A.;Karstaedt, Alan;Hale, Martin
通讯作者：
Hale, Martin
DOI：
10.1016/s0962-8479(05)80035-8
发表时间：
1995-08-01
期刊：
TUBERCLE AND LUNG DISEASE
影响因子：
--
作者：
ROWINSKAZAKRZEWSKA, E;SZOPINSKI, J;ZWOLSKAKWIEK, Z
通讯作者：
ZWOLSKAKWIEK, Z
影响因子：
9.6
作者：
RIEDER, HL;KELLY, GD;SNIDER, DE
通讯作者：
SNIDER, DE
影响因子：
5.9
作者：
KRAMER, F;MODILEVSKY, T;BARNES, PF
通讯作者：
BARNES, PF