Multi-institutional analysis on cost and quality of health care for data-based strategic improvement

本研究建立出院患者的临床和财务数据库并进行分析。在本研究的成本分析部分，虽然评估标准化的医院成本信息越来越重要，但尚未建立具有可靠的保健成本数据库的标准化成本计算方法。基于我们开发的标准化成本计算方法，我们分析了医疗保健成本的特征，并对日本的教学医院进行了全国性问卷调查。我们评估了患者安全系统的成本，重点是员工分配、会议、内部审计、员工教育和培训、事件报告、感染监测、传染病处理、药物使用管理、临床工程和患者咨询。安全活动数量的决定因素也进行了调查。我们的研究结果表明，医院范围内的患者安全活动对医院和国家医疗保健系统造成了显著的影响。为了客观评估医疗质量和绩效，我们开发了新的有效的风险调整方法，基于标准化出院数据中现成的一组数据，包括年龄、性别、初步诊断和编码合并症，来评估住院急性护理。为了充分利用诊断信息，我们采用了新的策略，利用详细的疾病编码信息和合并症的集合分类。我们的模型在处理特定疾病（如急性心肌梗死）死亡率风险调整的现有数据方面非常重要，并且可以提供一种新的方法来评估医院层面的临床表现。此外，我们还分析了资源的使用和卫生保健实践模式，这将反映卫生保健的质量和效率的某些方面。对实践中的变化进行分析，并以有效有用的形式表达出来，并根据科学客观的评估结果反馈给医院和专业人员，以进一步改进实践。少

The clinical and financial database of the discharged patients were established and analyzed in this study. For the cost-analysis part of this study, a standardized costing methodology with reliable cost database in health care had not been established although it was increasingly important to assess standardized hospital cost information. Based on a standardized costing methodology we developed, we analyzed the characteristics of the healthcare cost, and we conducted a national questionnaire survey of the teaching hospitals in Japan. We evaluated the costs of the systems for patient safety focused on staff assignment, meetings and conferences, internal audit, staff education and training, incident reporting, infection surveillance, infectious disposal, management of medication use, clinical engineering, and patient counseling. The determinants if the volume of safety activities were also investigated. Our results showed that hospital-wide activities for patient safety posed significan … More t costs to hospitals and national healthcare systems.For the objective assessment of healthcare quality and performance, we developed new and valid risk-adjustment methods to evaluate in-hospital acute care based on a set of data readily available in the standardized discharge data including age, gender, primary diagnosis, and coded comorbidity. To make the best use of diagnostic information, we used new strategies by use of detailed disease coding information and set classification of comorbidity. Our models were very important in handling the available data well for the risk-adjustment of mortality in specific diseases such as AMI and could offer a new approach to evaluate clinical performance at the hospital level. In addition, we analyzed the use of resources and the patterns of health care practice which would reflect some aspects of the quality and the efficiency of health care. The variation in practice was analyzed and expressed in valid and useful forms, and fedback to hospitals and professionals for further improvement of practice based on the results of scientific and objective assessment we developed. Less