Exploring the Pathways Revealed by International Sepsis Benchmarking.
Exploring the Pathways Revealed by International Sepsis Benchmarking.
复制标题
探索国际脓毒症基准测试揭示的途径。
DOI：
10.1097/ccm.0000000000003485
复制
发表时间：
2019
影响因子：
8.8
通讯作者：
Walkey,AllanJ
中科院分区：
文献类型：
--
作者：
Walkey,AllanJ
基准临床实践涉及比较当地的结果，以参考标准。为了准确地进行基准测试，团队需要：1）协调数据，2）对感兴趣的过程和/或结果进行无偏见的比较（1，2）。大多数基准测试的首要目的是识别高绩效和低绩效，发现导致高绩效和低绩效的特征，并针对旨在提高绩效的可修改特征进行更改。因此，基准测试是不断改进和创新的学习型医疗保健系统的重要组成部分（3）。最近，脓毒症已被推到世界舞台上，最近的世界卫生组织决议旨在改善其预防，诊断和管理（4）。作为该决议的一部分，第70届世界卫生大会通过了与脓毒症基准相关的多项建议，包括敦促会员国“应用和改进国际疾病分类系统的使用，以确定脓毒症的患病率和概况."，“开发和实施监测和评估工具，以集中关注和监测改善脓毒症结局的进展，包括发展和促进具体的流行病监测系统.”和“发展和实施标准和最佳护理."。然而，以前的努力基准国际脓毒症的发病率和结果是不够的。对脓毒症全球发病率和结局研究的系统性综述发现，低收入和中等收入国家普遍缺乏基于人群的脓毒症结局估计，并且由于国际疾病分类第9版编码、感染原因和地理因素的差异，显示出广泛的变异性，导致患者进入医院或ICU的不同入院标准（5）。
Benchmarking clinical practice involves comparison of local outcomes to a reference standard. In order to accurately benchmark, groups need to: 1) harmonize data and 2) produce unbiased comparisons of processes and/or outcomes of interest (1, 2). The overarching purpose of most benchmarking is to identify high and low performers, discover the characteristics responsible for high and low performance, and make changes targeting modifiable characteristics intended to improve performance. Thus, benchmarking is an essential part of a learning healthcare system of continuous improvement and innovation (3). Recently sepsis has been thrust onto the world stage by a recent World Health Organization resolution intended to improve its prevention, diagnosis, and management (4). As part of the resolution, the 70th annual World Health Assembly adopted multiple recommendations relevant to sepsis benchmarking, including urging member states to “apply and improve the use of International Classification of Diseasessystem to establish the prevalence and profile of sepsis…”, to “develop and implement monitoring and evaluation tools in order to focus attention on and monitor progress toward improving outcomes from sepsis, including the development and fostering of specific epidemiologic surveillance systems…” and to “develop and implement standard and optimal care…”. However, prior efforts to benchmark international sepsis incidence and outcomes have been inadequate. A systematic review of studies investigating the global incidence and outcomes of sepsis found that population-based estimates for sepsis outcomes were generally lacking in low-and middle-income countries, and exhibited wide variability due to differences in International Classification of Diseases, 9th Edition coding, infectious causes, and geographic factors leading to different admission criteria of patients into the hospital or ICU (5).