Variations in surgical outcomes associated with hospital compliance with safety practices.
Variations in surgical outcomes associated with hospital compliance with safety practices.
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DOI：
10.1016/j.surg.2011.12.001
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发表时间：
2012-05
期刊：
影响因子：
3.8
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Brooke, Benjamin S.;Dominici, Francesca;Pronovost, Peter J.;Makary, Martin A.;Schneider, Eric;Pawlik, Timothy M.
Leapfrog Group旨在通过促进医院遵守国家质量论坛（NQF）安全实践来提高患者安全。然而，尚不清楚这些安全措施的实施是否会改善高风险手术后的结果。我们对全国658家医院进行了横断面分析，这些医院对2005年跨越集团医院质量与安全调查做出了回应。从2004年至2006年，共有79,462名患者从医疗保险索赔数据中确定，他们接受了胰腺切除术、肝切除术、食管切除术、开放性主动脉瘤修复术、结肠切除术或胃切除术。随机效应logistic回归模型用于评估医院对NQF安全实践的依从性与风险调整后的并发症几率、抢救失败率和调整患者和医院水平混杂因素后的死亡率之间的相关性。在658家回应调查的医院中，41%的医院完全实施了NQF安全实践，59%的医院报告部分遵守了这些标准。与部分遵守NQF的医院相比，我们发现有重要证据表明，完全遵守NQF的医院在六种高风险手术中的任何一种手术后诊断并发症的可能性都有所增加（OR：1.13; 95%CI：1.03-1.25），但抢救失败的可能性降低（OR：0.82; 95%CI：0.71-0.96），死亡率降低（OR：0.80; 95%CI：0.71-0.91）。尽管术后并发症的发生率较高，但完全遵守安全规范的医院与高风险手术后抢救失败率和死亡率降低有关。这些结果强调了医院系统在促进安全和管理术后并发症方面的重要性。
The Leapfrog Group aims to improve patient safety by promoting hospital compliance with National Quality Forum (NQF) safe practices. It is unknown, however, whether implementation of these safety practices improve outcomes following high-risk operations. We conducted a cross-sectional analysis of 658 nationwide hospitals that responded to the 2005 Leapfrog Group Hospital Quality & Safety survey. A total of 79,462 patients were identified from Medicare claims data who underwent a pancreatectomy, hepatectomy, esophagectomy, open aortic aneurysm repair, colectomy or gastrectomy procedure from 2004 through 2006. Random-effects logistic regression models were used to estimate the association between hospital compliance with NQF safe practices and risk-adjusted odds of complications, failure rate to rescue, and mortality after adjusting for patient and hospital level confounders. Of the 658 hospitals that responded to surveys, 41% had fully implemented NQF safe practices and 59% reported partial compliance with these standards. Compared to hospitals with partial NQF compliance, we found significant evidence that hospitals with full compliance had an increased likelihood of diagnosing a complication following any of the six high-risk operations (OR: 1.13; 95%CI: 1.03–1.25), but had a decreased likelihood of failure to rescue (OR: 0.82; 95%CI: 0.71–0.96), and a decreased odds of mortality (OR: 0.80; 95%CI: 0.71–0.91). Despite having a higher rate of postoperative complications, hospitals fully complying with safe practices were associated with lower failure to rescue and reduced mortality following high-risk operations. These results highlight the importance of having hospitals systems in place to promote safety and manage postoperative complications.
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DOI：
10.1097/ta.0b013e31814856ad
发表时间：
2007-11-01
影响因子：
--
作者：
Haut, Elliott R.;Noll, Kathy;Pronovost, Peter J.
通讯作者：
Pronovost, Peter J.
影响因子：
9
作者：
Ghaferi, Amir A.;Birkmeyer, John D.;Dimick, Justin B.
通讯作者：
Dimick, Justin B.
影响因子：
2.8
作者：
Li B;Evans D;Faris P;Dean S;Quan H
通讯作者：
Quan H
影响因子：
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作者：
Nicholas, Lauren H.;Osborne, Nicholas H.;Dimick, Justin B.
通讯作者：
Dimick, Justin B.
影响因子：
3
作者：
Southern, DA;Quan, H;Ghali, WA
通讯作者：
Ghali, WA