Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles
Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles
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DOI：
10.1345/aph.1k041
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发表时间：
2007-06-01
影响因子：
2.9
通讯作者：
Devlin, John W.
中科院分区：
文献类型：
--
作者：
Fong, Jeffrey J.;Cecere, Karen;Devlin, John W.
背景：虽然3种不同的质量指标束被批准(美国自愿医院[VHA]、医疗保健改进研究所[IHI])或建议(医疗保健组织认证联合委员会[JCAHO])来评估严重脓毒症的临床实践，但怀疑这些束之间的质量指标的差异可能导致基准数据的差异。目的：比较IHI、JCAHO和VHA严重脓毒症束的依从性和与其相关的患者因素，并探索任何观察到差异的可能原因。方法：采用回顾性、非干预性设计，评估50名成年人(APACHE II评分25+/6，-6)结果：在450个床位的大学附属医院的重症监护病房中，很少有患者达到100%(IHI 6%，JCAHO 0%，VHA 6%)或75%或以上(IHI 22%，JCAHO 6%，VHA 22%)的质量指标。符合50%或以上质量指标的患者的数量在JCAHO(28%)和IHI(66%；P<；0.001)和VHA(60%；P<；0.001)之间差异显著，但IHI和VHA之间差异不显著(P=0.53)。当患者有休克(IHI、JCAHO、VHA)、APACHE II评分大于或等于25(VHA)、2个或更多器官衰竭(VHA)或存活住院(IHI)时，更有可能达到50%或更多的质量指标。我们确定了一些可能有助于解释这些差异的因素。结论：IHI、JCAHO和VHA严重脓毒症捆绑包之间的差异导致捆绑包遵从率的差异以及与这种差异相关的患者因素，并可能导致在机构之间进行基准实践时的混乱。未来的努力应该集中在开发单一有效和可靠的捆绑包，使提供者能够提高脓毒症护理的质量。
Background: While 3 different quality indicator bundles are either approved (Voluntary Hospitals of America [VHA], Institute for Healthcare Improvement [IHI]) or proposed (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) to rate clinical practices in treatment of severe sepsis, it is suspected that differences in the quality indicators among these bundles may lead to discrepant benchmarking data.Objective: To compare bundle compliance and patient factors associated with it among the IHI, JCAHO, and VHA severe sepsis bundles and explore possible reasons for any observed variability.Methods: Using a retrospective, noninterventional design, we evaluated 50 adults (APACHE II score 25 +/- 6, organ failure 2 +/- 1, and shock 52%) with severe sepsis who were admitted consecutively to an intensive care unit at a 450 bed university-affiliated hospital.Results: Few patients met 100% (IHI 6%, JCAHO 0%, VHA 6%) or 75% or greater (IHI 22%, JCAHO 6%, VHA 22%) of the quality indicators in each bundle. The number of patients who met 50% or more of the quality indicators varied significantly between JCAHO (28%) and both IHI (66%; p < 0.001) and VHA (60%; p < 0.001), but not between IHI and VHA (p = 0.53). Compliance with 50% or more of the quality indicators was more likely to occur when patients had shock (IHI, JCAHO, VHA), an APACHE II score greater than or equal to 25 (VHA), 2 or more organ failures (VHA), or survived hospitalization (IHI). We identified a number of factors that may help explain these differences.Conclusions: Differences among the IHI, JCAHO, and VHA severe sepsis bundles lead to variability in bundle compliance rates and the patient factors associated with the variability and may lead to confusion when benchmarking practices among institutions. Future efforts should focus on developing a single valid and reliable bundle that allows providers to improve the quality of sepsis care.