Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease
Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease
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DOI：
10.7326/0003-4819-144-12-200606200-00006
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发表时间：
2006-06-20
影响因子：
39.2
通讯作者：
Benjamin, Evan M.
中科院分区：
文献类型：
--
作者：
Lindenauer, Peter K.;Pekow, Penelope;Benjamin, Evan M.
背景资料：慢性阻塞性肺疾病（COPD）急性加重是美国成人住院治疗的10大主要原因之一。目的：评价为COPD急性加重住院患者提供的护理质量，并确定医院或患者特征是否影响治疗。设计：回顾性队列研究。设置：美国360家医院。患者：69 820例COPD急性加重住院患者。测量指标：美国内科医师学会和美国胸科医师学会制定的指南中包含的诊断和治疗建议的依从性;分析医院和患者特征之间的关联以及综合性能指标。结果：在69 820例患者中，66 276例（95%）接受了胸部X线摄影，63 715例（91%）接受了辅助供氧，67 515例（97%）接受了支气管扩张剂，59 240例（85%）接受了全身类固醇治疗，59 053例（85%）接受了抗生素治疗。总共有45 800人（66%）接受了整套建议的护理程序。许多参与者接受了无效的检查或治疗：16 607例（24%）接受了甲基黄嘌呤支气管扩张剂治疗，10 051例（14%）接受了痰液检测，8354例（12%）接受了急性肺功能测定，4299例（6%）接受了胸部物理治疗，1409例（2%）接受了粘液溶解药物治疗。总体而言，31519例患者（45%）接受了至少一种非推荐护理元素，22929例（33%）接受了理想护理，定义为所有推荐护理过程，没有非推荐护理过程。个别医院的表现差异很大;而老年患者和妇女更有可能比他们的同行得到理想的照顾，更高的COPD年入院量与医院绩效的改善无关。局限性：该研究使用的是行政数据，而不是图表审查，并且仅限于COPD的住院管理。结论：通过增加全身性皮质类固醇和抗生素治疗的使用，减少不必要的和潜在有害的治疗的使用，以及减少医院间实践的差异，可以改善因COPD急性加重住院患者的护理质量。
Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is 1 of the 10 leading causes of hospitalization among adults in the United States.Objective: To evaluate the quality of care provided to patients hospitalized for acute exacerbations of COPD and to determine whether hospital or patient characteristics influence treatment.Design: Retrospective cohort study.Setting: 360 hospitals throughout the United States.Patients: 69 820 patients hospitalized for acute exacerbations of COPD.Measurements: Adherence to diagnosis and treatment recommendations contained in guidelines produced by the American College of Physicians and the American College of Chest Physicians; analyses of associations between hospital and patient characteristics and composite measures of performance.Results: Of the 69 820 patients, 66 276 (95%) underwent chest radiography, 63 715 (91%) received supplemental oxygen, 67 515 (97%) received bronchodilators, 59 240 (85%) received systemic steroids, and 59 053 (85%) were given antibiotics. In total, 45 800 (66%) received this entire set of recommended care processes. Numerous participants received tests or treatments that were not beneficial: 16 607 (24%) were treated with methylxanthine bronchodilators, 10 051 (14%) had sputum testing, 8354 (12%) underwent acute spirometry, 4299 (6%) had chest physiotherapy, and 1409 (2%) were treated with mucolytic medications. Overall, 31 519 patients (45%) received at least 1 of these non-recommended care elements, and 22 929 (33%) received ideal care, defined as all of the recommended care processes and none of the non-recommended ones. Individual hospital performance varied widely; whereas older patients and women were more likely to receive ideal care than their counterparts, a higher annual volume of admissions for COPD was not associated with improved hospital performance.Limitations: The study used administrative data, not chart review, and was limited to the inpatient management of COPD.Conclusions: The quality of care for patients hospitalized for acute exacerbations of COPD may be improved by increasing the use of systemic corticosteroid and antibiotic therapy, decreasing the use of unnecessary and potentially harmful treatments, and reducing variation in practice across hospitals.