■代表性外科病例取样,而不是普遍审查,由美国退伍军人事务部(VA)和私营部门国家外科质量改进(QI)计划使用,以评估计划绩效并告知当地QI和绩效改进工作。然而,目前尚不清楚病例抽样对于识别存在安全或质量问题的医院是否有效.
■为了评估几个国家外科QI计划使用的抽样策略是否为医院提供了代表其整体质量和安全性的数据,以30天死亡率衡量。
■这项有效性比较研究是一项全国性的,对2016年1月1日至2020年9月30日期间在VA医院接受非心脏手术的成年患者(年龄≥18岁)的数据进行医院层面分析.数据来自VA手术质量改进计划(代表性样本)和VA企业数据仓库手术领域(100%的手术病例)。数据分析于2022年7月1日至12月21日进行。
■主要结局是术后30天死亡率。季度,风险调整后,使用样本和通用审查队列分别计算每家医院的30天死亡率观察与预期(O-E)比率。离群医院(即,死亡率高于预期的患者)使用O-E比显著大于1.0进行鉴定.
■在这项来自美国退伍军人事务部113家医院的数据研究中,样本队列包括502,953例手术病例,通用审查队列包括1,703,140例.代表性样本和通用样本中的大多数患者是男性(90.2%vs91.1%)和白人(74.7%vs74.5%)。总的来说,样本和普遍审查队列的30天死亡率分别为0.8%和0.6%,分别(P<.001)。超过2145个季度的数据,在抽样中,11.7%的医院被确定为异常值,在普遍审查中,13.2%的医院被确定为异常值。平均医院季度30天死亡率为0.4%,0.8%,仅使用样本确定的离群医院为0.9%,仅限普遍审查,以及两个数据源中的并发标识,分别。对于非抽样情况,离群医院的平均每季度30日死亡率为1.0%,非离群医院为0.5%.在样本中的异常医院季度中,47.4%与普遍审查同时确定。对于那些被普遍审查的人,使用样品同时鉴定了42.1%。
■在这个国家,医院层面的研究,国家外科QI项目采用的抽样策略发现,不到一半的医院围手术期死亡率高于预期.这些结果表明,抽样可能不足以代表整体手术计划的表现,也无法为利益相关者提供必要的数据来告知QI工作。
UNASSIGNED: Representative surgical
case sampling, rather than universal review, is used by US Department of Veterans Affairs (VA) and private-sector national surgical quality improvement (QI) programs to assess program performance and to inform local QI and performance improvement efforts. However, it is unclear whether
case sampling is robust for identifying hospitals with safety or quality concerns.
UNASSIGNED: To evaluate whether the sampling strategy used by several national surgical QI programs provides hospitals with data that are representative of their overall quality and safety, as measured by 30-day mortality.
UNASSIGNED: This comparative effectiveness study was a national, hospital-level analysis of data from adult patients (aged ≥18 years) who underwent noncardiac surgery at a VA hospital between January 1, 2016, and September 30, 2020. Data were obtained from the VA Surgical Quality Improvement Program (representative sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases). Data analysis was performed from July 1 to December 21, 2022.
UNASSIGNED: The primary outcome was postoperative 30-day mortality. Quarterly, risk-adjusted, 30-day mortality observed-to-expected (O-E) ratios were calculated separately for each hospital using the sample and universal review cohorts. Outlier hospitals (ie, those with higher-than-expected mortality) were identified using an O-E ratio significantly greater than 1.0.
UNASSIGNED: In this study of data from 113 US Department of Veterans Affairs hospitals, the sample cohort comprised 502 953 surgical cases and the universal review cohort comprised 1 703 140. The majority of patients in both the representative sample and the universal sample were men (90.2% vs 91.1%) and were White (74.7% vs 74.5%). Overall, 30-day mortality was 0.8% and 0.6% for the sample and universal review cohorts, respectively (P < .001). Over 2145 quarters of data, hospitals were identified as an outlier in 11.7% of quarters with sampling and in 13.2% with universal review. Average hospital quarterly 30-day mortality rates were 0.4%, 0.8%, and 0.9% for outlier hospitals identified using the sample only, universal review only, and concurrent identification in both data sources, respectively. For nonsampled cases, average hospital quarterly 30-day mortality rates were 1.0% at outlier hospitals and 0.5% at nonoutliers. Among outlier hospital quarters in the sample, 47.4% were concurrently identified with universal review. For those identified with universal review, 42.1% were concurrently identified using the sample.
UNASSIGNED: In this national, hospital-level study, sampling strategies employed by national surgical QI programs identified less than half of hospitals with higher-than-expected perioperative mortality. These findings suggest that sampling may not adequately represent overall surgical program performance or provide stakeholders with the data necessary to inform QI efforts.