The quality of ambulatory care delivered to children in the United States
The quality of ambulatory care delivered to children in the United States
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DOI：
10.1056/nejmsa064637
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发表时间：
2007-10-11
影响因子：
158.5
通讯作者：
McGlynn, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Mangione-Smith, Rita;DeCristofaro, Alison H.;McGlynn, Elizabeth A.
背景：由于缺乏全面的研究，人们对儿童护理质量缺陷的程度知之甚少。方法：我们评估了儿科门诊患者推荐的护理流程的实施程度。采用RAND-UCLA改进的德尔菲法制定质量指标。从12个大都市地区随机抽取1536名儿童的家长提供书面知情同意书，以便从研究招募日期前2年期间所有看过这些儿童的医务人员处获得医疗记录。训练有素的护士摘录了这些病历。综合质量分数的计算方法是将指定护理的记录次数除以指定护理过程的次数。结果根据病历资料，研究中患儿平均接受46.5%（95%可信区间[CI]， 44.5 ~ 48.4）的指征治疗。他们接受了67.6% （95% CI, 63.9 - 71.3）的急性医疗问题指征护理，53.4% （95% CI, 50.0 - 56.8）的慢性医疗状况指征护理，40.7% （95% CI, 38.1 - 43.4）的指征预防护理。质量因临床领域而异，上呼吸道感染的依从率为92.0% (95% CI, 89.9 - 94.1)，青少年预防服务的依从率为34.5% （95% CI, 31.0 - 37.9）。结论：儿童护理质量的缺陷与先前报道的成人护理质量的缺陷在程度上相似。减少这些明显赤字的战略是必要的。
BackgroundLittle is known about the magnitude of deficits in the quality of care delivered to children, since comprehensive studies have been lacking.MethodsWe assessed the extent to which care processes recommended for pediatric outpatients are delivered. Quality indicators were developed with the use of the RAND-UCLA modified Delphi method. Parents of 1536 children who were randomly selected from 12 metropolitan areas provided written informed consent to obtain medical records from all providers who had seen the children during the 2-year period before the date of study recruitment. Trained nurses abstracted these medical records. Composite quality scores were calculated by dividing the number of times indicated care was documented as having been ordered or delivered by the number of times a care process was indicated.ResultsOn average, according to data in the medical records, children in the study received 46.5% (95% confidence interval [CI], 44.5 to 48.4) of the indicated care. They received 67.6% (95% CI, 63.9 to 71.3) of the indicated care for acute medical problems, 53.4% (95% CI, 50.0 to 56.8) of the indicated care for chronic medical conditions, and 40.7% (95% CI, 38.1 to 43.4) of the indicated preventive care. Quality varied according to the clinical area, with the rate of adherence to indicated care ranging from 92.0% (95% CI, 89.9 to 94.1) for upper respiratory tract infections to 34.5% (95% CI, 31.0 to 37.9) for preventive services for adolescents.ConclusionsDeficits in the quality of care provided to children appear to be similar in magnitude to those previously reported for adults. Strategies to reduce these apparent deficits are needed.