Public Reporting of Healthcare Data

医疗保健数据的公开报告
  • 文章类型: English Abstract
    死亡病例报告是病因分析和趋势监测的重要信息来源,可以相对准确地反映人口的死亡情况和特征。它有助于了解人口的健康状况和医疗保健水平。特别部署住院死亡病例审查,不仅是卫生当局在医疗质量和安全方面的高度优先事项,而且是对重视人和生命的观念的切实贯彻。目前,对各专业死亡病例的审查缺乏科学和规范的评估,不包括孕产妇和新生儿病例。规范医疗机构死亡病例质量控制和管理,湖南省复苏质量控制中心制定了《医疗机构死亡病例质量控制与管理指南(2023)》。本指引工作组成员走访医疗机构,进行研究,审查了国内和国际来源的相关指南,并综合临床经验形成初步共识。这一共识已提交专家组进行多次讨论,经历了几次修改,最后,它以问卷的形式发送给专家以征求反馈。准则明确了范围,数据收集,和死亡病例质量控制的质量控制要求,为医疗机构死亡病例的质量控制和管理提供参考。
    The report of death cases is an important source of information for cause analysis and monitoring of trends, which can reflect the death situation and characteristics of a population in a relatively accurate manner. It helps understand the health status of the population and the level of healthcare. The special deployment of case review for in-hospital deaths is not only the high priority for health authorities in terms of quality and safety of medical care but also a practical implementation of the concept that values people and life. Currently, there is a lack of scientific and standardized evaluation for the review of death cases in various specialties, excluding maternal and neonatal cases. To standardize the quality control and management of death cases in medical institutions, the Guidelines for quality control and management of death cases in medical institutions (2023) has been developed by the Hunan Province Resuscitation Quality Control Center. The members of the working group of this guideline visited medical institutions, conducted research, reviewed relevant guidelines from domestic and international sources, and integrated clinical experience to form a preliminary consensus. This consensus was submitted to the expert group for multiple discussions, underwent several revisions, and finally, it was sent to the experts in the form of a questionnaire for feedback. The guidelines clarify the scope, data collection, and quality control requirements for death case quality control, providing a reference for the quality control and management of death cases in medical institutions.
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  • 文章类型: Journal Article
    背景:鉴于将骨科质量措施纳入医疗保险和医疗补助服务中心国家医院支付计划,本研究旨在评估公开报告的全髋关节置换术(THA)和全膝关节置换术(TKA)风险标准化再入院率(RSRR)和并发症发生率(RSCRs)是否在时间上与Medicare受益人的这些结局发生率下降相关.
    方法:对2010财年至2016财年接受医院住院髋关节和/或膝关节置换手术的患者进行了国家观察和医院级RSRR和RSCR的年度趋势评估。医院级别的比率是使用与公共报告中使用的相同的度量和方法计算的。然后使用密度图检查医院水平结果分布的年度趋势。
    结果:从2010财年到2016财年,并发症和再入院率和变化稳步下降。医院级RSCR和RSRR分别减少了33%和25%,分别。RSCR的四分位间距降低了18%(相对降低),RSRR的四分位间距降低了34%(相对降低)。并发症和再入院模型中风险变量的频率没有随着时间的推移而发生系统性变化,表明没有证据表明普遍存在偏见或向上编码。
    结论:这项研究表明,在THA和TKA之后,医院级别的并发症和再入院率以及医院级别表现的变化在与公共报告和与测量相关的财务激励措施的开始相吻合的时期内下降。结果发生率和差异的持续下降趋势表明,与2010财年相比,2016财年THA和TKA患者的临床结果在医院之间有稳步改善和更大的一致性。公众报道之间的相互作用,付款,医院编码实践很复杂,需要进一步研究。
    方法:预后III级。有关证据级别的完整描述,请参阅作者说明。
    BACKGROUND: Given the inclusion of orthopaedic quality measures in the Centers for Medicare & Medicaid Services national hospital payment programs, the present study sought to assess whether the public reporting of total hip arthroplasty (THA) and total knee arthroplasty (TKA) risk-standardized readmission rates (RSRRs) and complication rates (RSCRs) was temporally associated with a decrease in the rates of these outcomes among Medicare beneficiaries.
    METHODS: Annual trends in national observed and hospital-level RSRRs and RSCRs were evaluated for patients who underwent hospital-based inpatient hip and/or knee replacement procedures from fiscal year 2010 to fiscal year 2016. Hospital-level rates were calculated with use of the same measures and methodology that were utilized in public reporting. Annual trends in the distribution of hospital-level outcomes were then examined with use of density plots.
    RESULTS: Complication and readmission rates and variation declined steadily from fiscal year 2010 to fiscal year 2016. Reductions of 33% and 25% were noted in hospital-level RSCRs and RSRRs, respectively. The interquartile range decreased by 18% (relative reduction) for RSCRs and by 34% (relative reduction) for RSRRs. The frequency of risk variables in the complication and readmission models did not systematically change over time, suggesting no evidence of widespread bias or up-coding.
    CONCLUSIONS: This study showed that hospital-level complication and readmission rates following THA and TKA and the variation in hospital-level performance declined during a period coinciding with the start of public reporting and financial incentives associated with measurement. The consistently decreasing trend in rates of and variation in outcomes suggests steady improvements and greater consistency among hospitals in clinical outcomes for THA and TKA patients in the 2016 fiscal year compared with the 2010 fiscal year. The interactions between public reporting, payment, and hospital coding practices are complex and require further study.
    METHODS: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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  • 文章类型: Journal Article
    UNASSIGNED: Routine health information systems (RHISs) are crucial to informing decision-making at all levels of the health system. However, the use of RHIS data in low- and middle-income countries (LMICs) is limited due to concerns regarding quality, accuracy, timeliness, completeness and representativeness.
    UNASSIGNED: This study systematically reviewed technical, behavioural and organisational/environmental challenges that hinder the use of RHIS data in LMICs and strategies implemented to overcome these challenges.
    UNASSIGNED: Four electronic databases were searched for studies describing challenges associated with the use of RHIS data and/or strategies implemented to circumvent these challenges in LMICs. Identified articles were screened against inclusion and exclusion criteria by two independent reviewers.
    UNASSIGNED: Sixty studies met the inclusion criteria and were included in this review, 55 of which described challenges in using RHIS data and 20 of which focused on strategies to address these challenges. Identified challenges and strategies were organised by their technical, behavioural and organisational/environmental determinants and by the core steps of the data process. Organisational/environmental challenges were the most commonly reported barriers to data use, while technical challenges were the most commonly addressed with strategies.
    UNASSIGNED: Despite the known benefits of RHIS data for health system strengthening, numerous challenges continue to impede their use in practice.
    UNASSIGNED: Additional research is needed to identify effective strategies for addressing the determinants of RHIS use, particularly given the disconnect identified between the type of challenge most commonly described in the literature and the type of challenge most commonly targeted for interventions.
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  • 文章类型: Comparative Study
    Several systematic reviews (SRs) have been conducted on the COVID-19 outbreak, which together with the SRs on previous coronavirus outbreaks, form important sources of evidence for clinical decision and policy making. Here, we investigated the methodological quality of SRs on COVID-19, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Online searches were performed to obtain SRs on COVID-19, SARS, and MERS. The methodological quality of the included SRs was assessed using the AMSTAR-2 tool. Descriptive statistics were used to present the data. In total, of 49 SRs that were finally included in our study, 17, 16, and 16 SRs were specifically on COVID-19, MERS, and SARS, respectively. The growth rate of SRs on COVID-19 was the highest (4.54/month) presently. Of the included SRs, 6, 12, and 31 SRs were of moderate, low, and critically low quality, respectively. SRs on SARS showed the optimum quality among the SRs on the three diseases. Subgroup analyses showed that the SR topic (P < .001), the involvement of a methodologist (P < .001), and funding support (P = .046) were significantly associated with the methodological quality of the SR. According to the adherence scores, adherence to AMSTAR-2 items sequentially decreased in SRs on SARS, MERS, and COVID-19. The methodological quality of most SRs on coronavirus outbreaks is unsatisfactory, and those on COVID-19 have higher risks of poor quality, despite the rapid actions taken to conduct SRs. The quality of SRs should be improved in the future. Readers must exercise caution in accepting and using the results of these SRs.
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