Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?
Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?
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DOI：
10.1016/j.ajog.2006.06.020
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发表时间：
2006-09-01
影响因子：
9.8
通讯作者：
Murthy, Sumithra
中科院分区：
文献类型：
--
作者：
Grobman, William A.;Feinglass, Joe;Murthy, Sumithra
目的：本研究的目的是检查美国卫生保健研究和质量署的产科患者安全指标是否受到与安全环境无关的患者特异性和医院级特征的显著影响。研究设计：使用2001年伊利诺斯州所有非联邦医院的管理数据来分析医院产科创伤率与患者和医院层面因素的关系。采用多变量随机效应logistic回归分析来解释医院层面的聚类。结果：来自伊利诺伊州142家医院的175,374例分娩可用于分析。产科创伤的频率与多种患者特异性和医院层面的因素显著相关。具体来说，对于任何阴道分娩，早产、多胎妊娠、胎儿过度生长和妊娠延长都与产科创伤风险相关。对于自然分娩，先前的剖宫产也与创伤风险有关。产妇年龄与剖宫产和阴道分娩的创伤风险相关。就医院层面的因素而言，较高的年产生量和较高的剖宫产率与任何一种阴道分娩的创伤风险增加有关，而医院对其医疗记录进行编码的强度与所有分娩方式的创伤风险有关。结论：产科创伤的发生风险受患者和医院特点的显著影响，不能作为患者安全的良好指标。(c) 2006 Mosby, Inc。版权所有。
Objective: The objective of the study was to examine whether the United States Agency for Health Care Research and Quality obstetric patient safety indicators are significantly affected by patient-specific and hospital-level characteristics not related to the safety environment.Study design: Administrative data for all nonfederal Illinois hospitals in 2001 were used to analyze the association of a hospital's obstetric trauma rates with patient and hospital-level factors. Multivariable random effects logistic regression analyses was used to account for hospital-level clustering.Results: A total of 175,374 deliveries from 142 Illinois hospitals were available for analysis. The frequency of obstetric trauma was significantly associated with multiple patient-specific and hospital-level factors. Specifically, for any vaginal delivery, premature delivery, multiple gestation, excessive fetal growth, and prolonged pregnancy was associated with obstetric trauma risk. For spontaneous delivery, a prior cesarean was associated with trauma risk as well. Maternal age was associated with trauma risk at cesarean as well as at vaginal delivery. With regard to hospital-level factors, a higher annual delivery volume and a higher cesarean rate were associated with increased risk of trauma with either type of vaginal delivery, whereas in the intensity with which hospitals coded their medical records was associated with trauma risk for all routes of delivery.Conclusion: The risk of obstetric trauma is significantly influenced by both patient and hospital characteristics and is not a good indicator of patient safety. (c) 2006 Mosby, Inc. All rights reserved.