背景:自2009年以来,法兰德斯的医院质量政策,比利时,是围绕护理质量三合会建立的,其中包括认证,公众报告(PR)和检查。政策制定者目前正在反思这一三合会的附加值。
方法:我们对2009年至2020年之间发表的文献进行了叙述性审查,以检查影响认证的证据基础,公关和检查,无论是单独还是组合,对病人的过程和结果有影响。检查了以下患者结果:死亡率,逗留时间,再入院,患者满意度,不良结果,救援失败,坚持过程措施和规避风险。认证的影响,对这些结果的PR和检查被评估为阳性,中性(即没有观察到影响或报告混合结果)或负面。
目的:为了评估当前关于认证影响的证据基础,PR和检查患者的过程和结果。
结果:我们确定了69项研究,其中40人获得认证,24关于PR,三个关于检查,两个关于认证和公关。已确定的研究报告主要是低水平的证据(IV级,n=53),并且在实施的计划和患者人群方面具有异质性(在PR研究中通常很窄)。总的来说,在30篇认证文章中确定了中性分类,23用于PR,4用于检查。其中有10个叙述了好坏参半的结果。对于认证,发现了大量(n=12)关于遵守过程措施的积极研究。
结论:认证的个人影响,公关和检查,佛兰德医院质量的核心,被发现对患者预后有限。未来的研究应该研究多种质量改进策略的综合效果。
BACKGROUND: Since 2009, hospital quality policy in Flanders, Belgium, is built around a quality-of-care triad, which encompasses accreditation, public reporting (PR) and inspection. Policy makers are currently reflecting on the added value of this triad.
METHODS: We performed a narrative review of the literature published between 2009 and 2020 to examine the evidence base of the impact accreditation, PR and inspection, both individually and combined, has on patient processes and outcomes. The following patient outcomes were examined: mortality, length of stay, readmissions, patient satisfaction, adverse outcomes, failure to rescue, adherence to process measures and risk aversion. The impact of accreditation, PR and inspection on these outcomes was evaluated as either positive, neutral (i.e. no impact observed or mixed results reported) or negative.
OBJECTIVE: To assess the current evidence base on the impact of accreditation, PR and inspection on patient processes and outcomes.
RESULTS: We identified 69 studies, of which 40 were on accreditation, 24 on PR, three on inspection and two on accreditation and PR concomitantly. Identified studies reported primarily low-level evidence (level IV, n = 53) and were heterogeneous in terms of implemented programmes and patient populations (often narrow in PR research). Overall, a neutral categorization was determined in 30 articles for accreditation, 23 for PR and four for inspection. Ten of these recounted mixed results. For accreditation, a high number (n = 12) of positive research on adherence to process measures was discovered.
CONCLUSIONS: The individual impact of accreditation, PR and inspection, the core of Flemish hospital quality, was found to be limited on patient outcomes. Future studies should investigate the combined effect of multiple quality improvement strategies.