Prioritizing Quality Improvement in Surgery through Patient Safety Indicators.

描述(由申请者提供)：卫生服务研究有可能通过研究人口健康与其资源之间的关系来改变全球卫生保健。因此，在美国，正在加紧努力监测和提高患者护理和安全的质量。患者安全指标(PSI)由医疗研究和质量机构(AHRQ)开发，作为评估潜在医院内不良事件的一套参考。外科分专业为研究PSI提供了一个理想的环境，因为过程和结果密切相关。这项提案的目标是利用斯坦福大学的资源，为Tina Hernandez-Boussard博士，公共卫生硕士继续发展她的独立卫生服务研究人员的职业生涯，并建立外科亚专业卫生保健质量的全国趋势，确定优先领域，并使用管理数据确定护理质量的预测因素。外科次专科住院病人保健服务的国家质量尚未得到评估。尤其缺乏对按专业划分的不良事件趋势的严格评估。由于某些外科专科在不良后果中所占的比例不成比例，对外科专科中的PSI的检查将确定对公众健康具有潜在重大影响的领域。因此，这项建议的重点是通过广泛评估外科次级专科的PSI并确定哪些领域可以专注于质量努力以产生最大的公共健康影响，来提高美国医疗体系的质量。拟议的职业发展和研究计划将新的方法与现有的质量指标结合起来，使用管理数据在国家一级评估外科次级专科的患者安全性；评估外科次级专科的PSI中的时间趋势分析；并确定外科次级专科的患者、医生和组织护理质量的预测因素。这项关于人口健康及其资源之间关系的研究有可能在未来十年拯救大量生命。制定PSI是为了研究这种关系，并确定可以改善不良结果的领域。完成本提案中概述的具体目标将为医院集中手术质量改进努力提供基础(目标1)，医院将能够对其整体质量改进表现进行评级并确定改进机会(目标2)，模型将建议手术中可预测护理质量较差的领域，因此应重点关注(目标3)。这些开发和研究计划涉及AHRQ研究议程上的几个优先问题，包括患者安全和加强质量测量，以减少并发症发生率，并在未来十年潜在地提高卫生保健质量。

DESCRIPTION (provided by applicant): Health services research has the potential to transform global health care through the study of the relationship between a population's health and its resources. Accordingly, in the US there are mounting efforts to monitor and improve quality of patient care and safety. Patient Safety Indicators (PSIs) were developed by the Agency for Healthcare Research and Quality (AHRQ) as a set of references to assess potential in-hospital adverse events. Surgical subspecialties offer an ideal setting to study PSIs, as processes and outcomes are closely related. The goal of this proposal is to utilize resources at Stanford University for Tina Hernandez- Boussard, Ph.D., MPH to continue to develop her career as an independent health services researcher and to establish national trends in health care quality in surgical subspecialties, identify areas of priority, and determine predictors of quality of care using administrative data. The national quality of inpatient health care services in surgical subspecialties has not been assessed. Particularly lacking are rigorous evaluations of trends in adverse events by specialty. As certain surgical subspecialties account for a disproportionate share of adverse outcomes, the examination of PSIs in surgical subspecialties will identify areas with potential large impacts on public health. Accordingly, the focus of this proposal is on quality improvement of the US healthcare system through extensive evaluation of PSIs in surgical subspecialties and identification of areas where quality efforts can be focused to produce the greatest public health impact. The proposed career development and research plan couples new methodologies with current quality indicators using administrative data to assess patient safety in surgical subspecialties at the national level; evaluates time trend analyses in PSIs in surgical subspecialties; and determines patient, physician, and organizational predictors of quality of care in surgical subspecialties. This research on the relationship between a population's health and its resources has the potential to save a substantial number of lives in the next decade. PSIs were developed to study this relationship and identify areas where improvement of adverse outcomes is achievable. Accomplishing the specific aims outlined in this proposal will provide a foundation for hospitals to focus their surgical quality improvement efforts (Aim #1), hospitals will be able to rank their overall quality improvement performance and identify opportunities for improvement (Aim #2) and models will suggest areas in surgery that are predictive of poor quality of care and therefore merit focus (Aim #3). These development and research plans address several priority issues on the AHRQ research agenda including patient safety and strengthening quality measurement to reduce complication rates and potentially improve health care quality in the next decade.