Prioritizing Quality Improvement in Surgery through Patient Safety Indicators.

描述（由申请人提供）：卫生服务研究有可能通过研究人口的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，有越来越多的努力来监测和提高病人护理和安全的质量。患者安全性指标（PSI）由美国医疗保健研究和质量局（AHRQ）开发，作为评估潜在院内不良事件的一组参考。外科亚专业提供了一个理想的环境，研究PSIs的过程和结果是密切相关的。这项提案的目标是利用斯坦福大学的资源，为蒂娜埃尔南德斯-布萨尔博士，公共卫生硕士继续发展她的职业生涯作为一个独立的卫生服务研究人员，并建立在外科专科医疗保健质量的国家趋势，确定优先领域，并确定使用管理数据的护理质量的预测因素。全国外科专科住院医疗保健服务的质量尚未得到评估。尤其缺乏按专业对不良事件趋势的严格评估。由于某些外科亚专业在不良结局中所占比例不成比例，因此对外科亚专业的PSI进行检查将确定对公共卫生有潜在重大影响的领域。因此，该提案的重点是通过广泛评估外科专科的PSI和确定可以集中质量努力以产生最大公共卫生影响的领域来提高美国医疗保健系统的质量。拟议的职业发展和研究计划夫妇的新方法与当前的质量指标，使用行政数据，以评估患者的安全性，在外科专科在国家一级的外科专科;评估时间趋势分析，在PSI在外科专科;并确定患者，医生和组织的预测因子的护理质量在外科专科。这项关于人口健康与其资源之间关系的研究有可能在今后十年挽救大量生命。开发PSI是为了研究这种关系，并确定可以改善不良结局的领域。实现本提案中概述的具体目标将为医院集中其手术质量改进工作（目标1）提供基础，医院将能够对其整体质量改进绩效进行排名并识别改进机会（目标2），模型将建议手术中预测护理质量差的领域，因此值得关注（目标3）。这些发展和研究计划解决了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，并可能在未来十年提高医疗质量。

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.