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[BMJ最新论文]: 美国医院认证与患者预后的相关性:观察性研究
2018年12月18日 时讯速递, 进展交流 暂无评论

Research

Association between patient outcomes and accreditation in US hospitals: observational study

Miranda B Lam, Jose F Figueroa, Yevgeniy Feyman, et al.BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4011 (Published 18 October 2018)

Cite this as: BMJ 2018;363:k4011M

Responses

Abstract

Objectives 目的

To determine whether patients admitted to US hospitals that are accredited have better outcomes than those admitted to hospitals reviewed through state surveys, and whether accreditation by The Joint Commission (the largest and most well known accrediting body with an international presence) confers any additional benefits for patients compared with other independent accrediting organizations.

明确入住经过认证的美国医院的患者临床预后是否优于州政府审核医院,以及联合委员会(国际最大最知名的认证机构)认证与其他独立认证机构相比是否对患者有益

Design 设计

Observational study.

观察性研究

Setting 场景

4400 hospitals in the United States, of which 3337 were accredited (2847 by The Joint Commission) and 1063 underwent state based review between 2014 and 2017.

美国4400所医院,其中3337所医院经过认证(2847所由联合委员会认证),其余1063所医院于2014年至2017年接受州政府审查。

Participants 研究对象

4 242 684 patients aged 65 years and older admitted for 15 common medical and six common surgical conditions and survey respondents of the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS).

因15种常见内科疾病及6种常见外科疾病住院的4,242,684名年龄65岁以上患者,且回复HCAHPS调查问卷。

Main outcome measures 主要预后指标

Risk adjusted mortality and readmission rates at 30 days and HCAHPS patient experience scores. Hospital admissions were identified from Medicare inpatient files for 2014, and accreditation information was obtained from the Centers for Medicare and Medicaid Services and The Joint Commission.

30天风险校正病死率及再入院率,HCAHPS患者体验评分。从2014年Medicare住院患者文件中查询住院情况,医院认证信息来自Medicare和Medicaid服务中心及联合委员会。

Results 结果

Patients treated at accredited hospitals had lower 30 day mortality rates (although not statistically significant lower rates, based on the prespecified P value threshold) than those at hospitals that were reviewed by a state survey agency (10.2% v 10.6%, difference 0.4% (95% confidence interval 0.1% to 0.8%), P=0.03), but nearly identical rates of mortality for the six surgical conditions (2.4% v 2.4%, 0.0% (−0.3% to 0.3%), P=0.99). Readmissions for the 15 medical conditions at 30 days were significantly lower at accredited hospitals than at state survey hospitals (22.4% v 23.2%, 0.8% (0.4% to 1.3%), P<0.001) but did not differ for the surgical conditions (15.9% v 15.6%, 0.3% (−1.2% to 1.6%), P=0.75). No statistically significant differences were seen in 30 day mortality or readmission rates (for both the medical or surgical conditions) between hospitals accredited by The Joint Commission and those accredited by other independent organizations. Patient experience scores were modestly better at state survey hospitals than at accredited hospitals (summary star rating 3.4 v 3.2, 0.2 (0.1 to 0.3), P<0.001). Among accredited hospitals, The Joint Commission did not have significantly different patient experience scores compared to other independent organizations (3.1 v 3.2, 0.1 (−0.003 to 0.2), P=0.06).

在经过认证医院接受治疗的患者30天病死率低于州政府调查机构审核医院(尽管根据预设P值,统计学没有差异)(10.2% v 10.6%, 差异 0.4% (95% 可信区间 0.1% to 0.8%), P=0.03),但6种常见外科疾病的病死率几乎相同 (2.4% v 2.4%, 0.0% (−0.3% to 0.3%), P=0.99)。认证医院收治的15种常见内科疾病患者30天再入院率显著低于州政府审核医院 (22.4% v 23.2%, 0.8% (0.4% to 1.3%), P<0.001),但外科疾病住院患者并无差异 (15.9% v 15.6%, 0.3% (−1.2% to 1.6%), P=0.75)。由联合委员会认证的医院与其他独立机构认证医院间30天病死率及再住院率没有统计学显著差异。州政府审核医院收治患者的体验评分略好于认证医院(汇总星级评定 3.4 v 3.2, 0.2 (0.1 to 0.3), P<0.001)。在认证医院中,联合委员会认证医院与其他独立机构认证医院间患者体验评分无显著差异(3.1 v 3.2, 0.1 (−0.003 to 0.2), P=0.06)。

Conclusions 结论

US hospital accreditation by independent organizations is not associated with lower mortality, and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.

本研究结果显示,由独立机构认证的美国医院并不伴随病死率降低,仅伴随15种常见内科疾病患者30天内再住院率轻度降低。没有证据表明,与其他独立机构认证医院相比,患者选择联合委员会认证的医院有任何获益。

Peer review



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