Evaluating Obstetrical Residency Programs Using Patient Outcomes
Evaluating Obstetrical Residency Programs Using Patient Outcomes
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DOI：
10.1001/jama.2009.1356
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发表时间：
2009-09-23
影响因子：
120.7
通讯作者：
Epstein, Andrew J.
中科院分区：
文献类型：
--
作者：
Asch, David A.;Nicholson, Sean;Epstein, Andrew J.
背景病人的结果已经被用来评估医院和医生的表现;目的评估妇产科住院医师项目是否可以通过其毕业生提供的护理质量进行评估。设计、设置和患者回顾性分析1992年至2007年期间所有佛罗里达和纽约产科医院的出院情况，代表了4906169分娩的4124产科医生从107个美国住院医师programmes.Main结果测量产妇并发症的9个措施阴道和剖宫产反映撕裂伤，出血，和所有其他并发症后阴道分娩，出血，感染，和所有其他并发症后剖宫产;结果产科医生的住院实习计划与产妇并发症发生率的实质性变化相关。在风险标准化主要孕产妇并发症发生率最低的五分之一中，接受住院医师培训的产科医生治疗的妇女的调整后并发症发生率为13.6%，比接受最高五分之一中的产科医生治疗的妇女的10.3%的调整后并发症发生率高出约三分之一（绝对差异为3.3%; 95%置信区间为2.8%-3.8%）。基于9项指标中的每一项的住院医师项目排名相似。调整医疗执照考试成绩并没有实质上改变程序ranking.Conclusions妇产科培训课程可以排名的产妇并发症发生率的毕业生的病人。这些排名在各种类型的并发症中是稳定的，与居民的执照考试分数无关。美国医学会杂志2009;302（12）：1277-1283
Context Patient outcomes have been used to assess the performance of hospitals and physicians; in contrast, residency programs have been compared based on non-clinical measures.Objective To assess whether obstetrics and gynecology residency programs can be evaluated by the quality of care their alumni deliver.Design, Setting, and Patients A retrospective analysis of all Florida and New York obstetrical hospital discharges between 1992 and 2007, representing 4 906 169 deliveries performed by 4124 obstetricians from 107 US residency programs.Main Outcome Measures Nine measures of maternal complications from vaginal and cesarean births reflecting laceration, hemorrhage, and all other complications after vaginal delivery; hemorrhage, infection, and all other complications after cesarean delivery; and composites for vaginal and cesarean deliveries and for all deliveries regardless of mode.Results Obstetricians' residency program was associated with substantial variation in maternal complication rates. Women treated by obstetricians trained in residency programs in the bottom quintile for risk-standardized major maternal complication rates had an adjusted complication rate of 13.6%, approximately one-third higher than the 10.3% adjusted rate for women treated by obstetricians from programs in the top quintile (absolute difference, 3.3%; 95% confidence interval, 2.8%-3.8%). The rankings of residency programs based on each of the 9 measures were similar. Adjustment for medical licensure examination scores did not substantially alter the program ranking.Conclusions Obstetrics and gynecology training programs can be ranked by the maternal complication rates of their graduates' patients. These rankings are stable across individual types of complications and are not associated with residents' licensing examination scores. JAMA. 2009;302(12):1277-1283