Hospital-reported data on the pneumonia quality measure "Time to First Antibiotic Dose" are not associated with inpatient mortality: results of a nationwide cross-sectional analysis.
Hospital-reported data on the pneumonia quality measure "Time to First Antibiotic Dose" are not associated with inpatient mortality: results of a nationwide cross-sectional analysis.
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医院报告的肺炎质量指标“首次服用抗生素时间”数据与住院患者死亡率无关：全国横断面分析的结果。
DOI：
10.1111/j.1553-2712.2011.01053.x
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
MarkCourtney,D
中科院分区：
文献类型：
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作者：
Quattromani,Erin;Powell,EmilieS;Khare,RahulK;Cheema,Navneet;Sauser,Kori;Periyanayagam,Usha;Pirotte,MatthewJ;Feinglass,Joe;MarkCourtney,D
Academic Emergency Medicine 2011; 18：496-503 © 2011由学术急救医学协会摘要目标：关于医疗保险和医疗补助服务中心（CMS）的“首次抗生素剂量时间”（TFAD）质量测量存在重大争议。本研究的目的是确定是否从急诊科（艾德）收治的肺炎患者的TFAD措施的医院性能与mortarity.Methods：这是一个横断面分析95,704成人艾德入院与肺炎的主要诊断从530家医院在2007年全国住院病人样本。样本与2007年CMS医院比较数据合并，医院被归类为TFAD性能四分位数。通过卡方检验评价TFAD性能与住院死亡率的单变量相关性。建立了一个人口平均logistic回归模型，该模型使用住院死亡率的可交换工作相关矩阵，调整了年龄、性别、共病情况、周末入院、付款人状态、收入水平、医院规模、医院位置、教学状况和TFAD性能。 在校正分析中，年龄增加与死亡率增加相关，比值比（OR）>2.3。 未校正的住院死亡率为4.1%（95%置信区间[CI]= 3.9%至4.2%）。 至死亡的中位时间为5天（第25 - 75四分位数间距= 2-11）。 所有医院的平均TFAD质量性能为77.7%（95% CI = 77.6%-77.8%）。 与最低TFAD四分位数相比，最高TFAD四分位数的死亡率风险调整OR为0.89（95% CI =0.77 - 1.02）。 第二高性能的四分位数OR为0.94（95%CI = 0.82至1.08），第三高性能的四分位数为0.91（95%CI = 0.79至1.05）。结论：在这个全国性的异质性2007年样本，有没有公开报道的TFAD质量指标的性能和肺炎住院死亡率之间的关联。
ACADEMIC EMERGENCY MEDICINE 2011; 18:496–503 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:Significant controversy exists regarding the Centers for Medicare & Medicaid Services (CMS) “time to first antibiotics dose” (TFAD) quality measure. The objective of this study was to determine whether hospital performance on the TFAD measure for patients admitted from the emergency department (ED) for pneumonia is associated with decreased mortality.Methods:This was a cross‐sectional analysis of 95,704 adult ED admissions with a principal diagnosis of pneumonia from 530 hospitals in the 2007 Nationwide Inpatient Sample. The sample was merged with 2007 CMS Hospital Compare data, and hospitals were categorized into TFAD performance quartiles. Univariate association of TFAD performance with inpatient mortality was evaluated by chi‐square test. A population‐averaged logistic regression model was created with an exchangeable working correlation matrix of inpatient mortality adjusted for age, sex, comorbid conditions, weekend admission, payer status, income level, hospital size, hospital location, teaching status, and TFAD performance.Results:Patients had a mean age of 69.3 years. In the adjusted analysis, increasing age was associated with increased mortality with odds ratios (ORs) of >2.3. Unadjusted inpatient mortality was 4.1% (95% confidence interval [CI] = 3.9% to 4.2%). Median time to death was 5 days (25th–75th interquartile range = 2–11). Mean TFAD quality performance was 77.7% across all hospitals (95% CI = 77.6% to 77.8%). The risk‐adjusted OR of mortality was 0.89 (95% CI = 0.77 to 1.02) in the highest performing TFAD quartile, compared to the lowest performing TFAD quartile. The second highest performing quartile OR was 0.94 (95% CI = 0.82 to 1.08), and third highest performing quartile was 0.91 (95% CI = 0.79 to 1.05).Conclusions:In this nationwide heterogeneous 2007 sample, there was no association between the publicly reported TFAD quality measure performance and pneumonia inpatient mortality.