Hospital quality indicators

尽管个别临床医生的知识和实践对于高质量的护理很重要，但卫生保健专业人员在团体或护理系统内执业的情况越来越多。这些系统在预防差错、协调环境和从业人员之间的护理以及确保在需要时提供相关、准确的信息方面发挥作用，是提供高质量护理的关键系统要素。这项拟议的研究将在854家以上医院的样本中评估医院质量改进结构和实践与选定的质量指标之间的关系。提出了两个具体的研究目标：(1)评估医院质量改进基础设施与医院层面质量指标之间的联系；(2)确定具体质量改进做法影响医院层面质量指标的组织和市场条件。这项研究将把关于医院质量改进结构和实践的独特调查数据与AHRQ的HCUP计划下的医院出院摘要数据相结合。运用多元统计分析方法，考察医院QI实施的范围、持续时间和强度对医院级临床质量指标的主要影响。这项研究还将研究质量领导力、组织基础设施和质量资源以及其他组织和市场特征如何协调医院QI实践和医院级临床质量指标之间的关系。研究结果将为政策制定者、认证机构和消费者提供更准确的信息，说明医院QI的哪些维度与选定的医院质量指标具有最强的相关性。因此，研究结果可能为质量改进标准和基准提供基础，这些标准和基准不仅强调广泛可用的质量指标，而且还强调那些可能受医院经理和临床医生的QI干预的指标。其次，在一定程度上，如果我们的研究结果确定了特定的医院质量改进方法与更积极的质量指标相关的条件，医院可能能够针对那些特别适合其运营环境的策略。

Although the knowledge and practices of individual clinicians are important for high quality care, it is increasingly the case that health care professionals practice within groups or systems of care. The functioning of those systems in preventing errors, coordinating care among settings and practitioners, and ensuring that relevant, accurate information is available when needed are critical systemic elements of providing high quality care. The proposed study will assess the relationship between hospital quality improvement structures and practices and selected quality indicators in a sample of 854+ hospitals. Two specific study objectives are advanced: (1) to assess the association between hospital quality improvement infrastructure and quality indicators at the hospital level; and (2) to identify the organizational and market conditions under which specific quality improvement practices affect quality indicators at the hospital level. The study will combine unique survey data on hospital quality improvement structures and practices with data derived from hospital discharge abstract data under the HCUP program at AHRQ. Using multivariate statistical analyses, we will examine the main effects of the scope, duration and intensity of hospital QI implementation on hospital-level clinical quality indicators. The study will also examine how leadership for quality, organizational infrastructure and resources for quality, and other organizational and market characteristics moderate the relationship between hospital QI practices and hospital-level clinical quality indicators. Study results will provide policy makers, accrediting bodies, and consumers with more precise information regarding which dimensions of hospital QI exhibit the strongest association with select hospital quality indicators. Study findings may therefore provide the basis for quality improvement standards and benchmarks that emphasize not only widely available quality indicators but also those indicators that are potentially amenable to QI interventions by hospital managers and clinicians. Second, To the extent that our study findings identify the conditions under which particular approaches to hospital quality improvement are associated with more positive quality indicators, hospitals may be able to target those strategies that are particularly suited to their operating environment.