Quality of care is associated with survival in vulnerable older patients
Quality of care is associated with survival in vulnerable older patients
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DOI：
10.7326/0003-4819-143-4-200508160-00008
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发表时间：
2005-08-16
影响因子：
39.2
通讯作者：
Wenger, NS
中科院分区：
文献类型：
--
作者：
Higashi, T;Shekelle, PG;Wenger, NS
背景资料：虽然医疗护理质量的评估往往依赖于护理过程的措施，这些过程中的措施，在日常临床护理和随后的病人outcome.Objective性能之间的联系尚不清楚：检查之间的联系，病人接受的护理质量和他们的生存设计：观察性队列研究设置：两个管理的护理组织。1998年7月1日至1999年7月31日期间连续入组管理式护理组织的65岁或以上社区居住高危患者。患者接受的护理质量（通过一套涵盖22种临床状况的质量指标来衡量）及其在随后3年的生存率。372名弱势老年患者符合平均21项质量指标（范围，8至54），平均接受了质量指标（范围，27%至88%）中规定的护理过程的53%。在3年随访期间，86例（23%）患者死亡。质量评分与3年生存率呈分级正相关。在对性别、健康状况和卫生服务使用进行调整后，质量评分与前500天的死亡率无关，但质量评分越高，500天后的死亡率越低（风险比，0.64 [95%CI，0.49至0.84]，质量评分高10%）。局限性：观察设计限制因果推理的护理质量对survival.Conclusions的影响：更好的性能过程质量的措施是密切相关的社区居住的弱势老年人更好的生存。
Background: Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent patient outcomes is unclear.Objective: To examine the link between the quality of care that patients received and their survival.Design: Observational cohort study.Setting: Two managed care organizations.Patients: Community-dwelling high-risk patients 65 years of age or older who were continuously enrolled in the managed care organizations from 1 July 1998 to 31 July 1999.Measurements: Quality of care received by patients (as measured by a set of quality indicators covering 22 clinical conditions) and their survival over the following 3 years.Results: The 372 vulnerable older patients were eligible for a mean of 21 quality indicators (range, 8 to 54) and received, on average, 53% of the care processes prescribed in quality indicators (range, 27% to 88%). Eighty-six (23%) persons died during the 3-year follow-up. There was a graded positive relationship between quality score and 3-year survival. After adjustment for sex, health status, and health service use, quality score was not associated with mortality for the first 500 days, but a higher quality score was associated with lower mortality after 500 days (hazard ratio, 0.64 [95% Cl, 0.49 to 0.84] for a 10% higher quality score).Limitations: The observational design limits causal inference regarding the effect of quality of care on survival.Conclusions: Better performance on process quality measures is strongly associated with better survival among community-dwelling vulnerable older adults.