Cross-sectional analysis of hospitalist prevalence and quality of care in California.
Cross-sectional analysis of hospitalist prevalence and quality of care in California.
复制标题
加州住院率和护理质量的横断面分析。
DOI：
10.1002/jhm.609
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发表时间：
2010
影响因子：
2.6
通讯作者：
Auerbach,AndrewD
中科院分区：
文献类型：
--
作者：
Vasilevskis,EduardE;Knebel,RJustin;Dudley,RAdams;Wachter,RobertM;Auerbach,AndrewD
医院领导通常为住院医师团体提供财务支持，通常期望在公开报告的质量指标上提高绩效。住院医师的存在是否与医院水平绩效的差异相关尚不清楚。首先评估住院医师患病率和质量绩效之间的关系。研究对象：参与者：共有208家加州医院参与自愿报告计划。干预：对了解住院医师用于患者护理的医院工作人员进行调查。测量：3年内16项公开报告的质量过程测量。医疗条件：急性心肌梗塞（AMI）;充血性心力衰竭（CHF）;和肺炎。使用多变量模型，我们评估了住院医师的存在和错过的质量机会的百分比之间的关系，为每个过程measure. AUTS的208个合格的医院，170（82%）有住院医师服务。调整后，有住院医生的医院在入院时评估的心脏和肺炎指标方面的表现相似，在出院时评估的CHF指标方面遗漏的过程较少。在有住院医生的研究中心中，住院医生收治的患者估计百分比每增加10%，（P< 0.001）入院时错过AMI的质量机会，（P< 0.001），0.5%（P= 0.004）和1.5%（P= 0.006）在出院时评估的AMI、CHF和肺炎的质量机会减少，结论：加州住院医师的存在与公开报道的过程测量的性能的适度改善有关。住院医师是直接提高质量还是仅仅反映医院在质量方面的投资水平仍然是未来研究的主题。医院医学杂志2010;5：200-207。© 2010医院医学协会。
BACKGROUNDHospital leaders usually provide financial support to hospitalists groups, often with an expectation of improved performance on publicly reported quality metrics. Whether the presence of hospitalists is associated with differences in hospital‐level performance is unknown.OBJECTIVEAssess the relationship between hospitalist prevalence and quality performance.DESIGNCross‐sectional study.PARTICIPANTSA total of 208 California hospitals participating in a voluntary reporting initiative.INTERVENTIONSurvey of hospital personnel with knowledge of the utilization of hospitalists for patient care.MEASUREMENTSSixteen publicly reported quality process measures across 3 medical conditions: acute myocardial infarction (AMI); congestive heart failure (CHF); and pneumonia. Using multivariable models, we assessed the relationship between the presence of hospitalists and the percentage of missed quality opportunities for each process measure.RESULTSOf 208 eligible hospitals, 170 (82%) had hospitalist services. After adjustment, hospitals with hospitalists had similar performance for cardiac and pneumonia measures assessed at admission and fewer missed processes for CHF measures assessed at discharge. Among sites with hospitalists, every 10% increase in the estimated percentage of patients admitted by hospitalists was associated with 0.5% fewer (P< 0.001) missed quality opportunities for AMI at admission, and 0.6% (P< 0.001), 0.5% (P= 0.004), and 1.5% (P= 0.006) fewer missed quality opportunities for AMI, CHF, and pneumonia assessed at discharge, respectively.CONCLUSIONSThe presence of hospitalists in California was associated with modest improvements in performance on publicly reported process measures. Whether hospitalists directly improve quality or simply reflect a hospital's level of investment in quality remains a subject for future study. Journal of Hospital Medicine 2010;5:200–207. © 2010 Society of Hospital Medicine.