Evaluation of Healthcare Quality by Comparison of Clinical Indicators Among Hospitals

通过对国外基本临床指标的研究，开发出可供日本医院使用的基本临床指标。同时，对压疮的发生情况进行了调查，对不同医院的压疮情况进行了比较，并对压疮作为医院护理指标的问题进行了探讨。通过这些试验，得出以下结论：1.由于医院的侧重点和职能不同，有效的临床指标在不同的医院是不同的。应制定一套基本的临床指标，以便医院从中选择有用的指标。2.同一指标的计算方式不应在不同的医院之间有所不同，以使指标的比较准确。要严格界定和规范指标的计算方法。3.对必要的数据进行修正，回溯计算指标，工作量太大。建议编制可在工作现场日常使用的标准化数据表，用于常规测量护理质量。4.根据诊断程序组合(DPC)要求提交报销的数据集是标准化出院数据集之一。将可从这些数据中得出的某些指标系统化似乎是有用的。另一方面，数据集应考虑绩效指标的计算。电子病历系统可能是最强大的工具之一，可以纠正必要的数据，以计算绩效指标，以提高护理质量和效率。

Basic Clinical Indicators, which could be used at Japanese Hospitals, are developed by researching those of foreign countries. In the mean time, the following was explored : the occurrence of pressure ulcers was surveyed, a comparison among Hospitals was performed, and the problems to use the occurrence of pressure ulcers as a Hospital care indicator were discussed. Through these trials, conclusions regarding the use of clinical indicators as Hospital performance measures are found as follows :1.Effective clinical indicators are not the same among Hospitals because of the different emphasis and function of each Hospital. A set of Basic Clinical Indicators should be developed from which a Hospital can select useful indicators from.2.The manner of calculation of the same indicator should not be different among Hospitals so that the comparisons of indicators be accurate. The method of calculation of indicators should be strictly defined and standardized.3.To correct necessary data to calculate indicators retrospectively would be too much work. Preparing a standardized data form which could be used daily at the work site is recommended for measuring the care quality routinely.4.A data set, which is required to submit for reimbursement under DPC(Diagnosis Procedure Combination), is one of the standardized discharge data set. It seems useful to systematize the certain indicators that can be derived from these data. On the other hand, the data set should be planned to consider the calculation of performance measures.Electrical Medical Record System could be one of the strongest tools for correcting the necessary data to calculate performance measures for the improvement of care quality and efficiency.