Organizational Intent, Organizational Structures, and Reviewer Mental Models Influence Mortality Review Processes

Inas S. Khayal PhD , Rebecca L. Butcher MS, MPH , Colin H. McLeish MD, MBA , Yujia Shentu MD, MS , Amber E. Barnato MD, MPH, MS
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引用次数: 0

Abstract

Objective

To identify the factors that influence the mortality review process at health systems, including how mortality review is conducted, cases are adjudicated, and results are used.

Methods

We conducted a qualitative analysis of the mortality review processes of 6 US health systems from February 1, 2021 to June 31, 2021. The data sources included individual and small-group semi-structured interviews with mortality review team members and a content analysis of site artifacts (eg, guiding principles, chart abstraction forms, review workflows, and clinical pathways developed from past mortality reviews). We analyzed each site’s mortality review process, goals and incentives for mortality review, historical and evolving aspects of mortality review, personnel involved, and post-review use of findings.

Results

Across the 6 systems, we interviewed a total of 24 mortality review experts and analyzed 26 site documents. We identified 3 thematic factors that influence mortality review processes: organizational intent, organizational structures for mortality review, and the mental models of individuals involved in the review process. Two subthemes emerged within organizational intent: (1) identifying preventable deaths to lower (clinical or financial) risk and (2) using death cases to guide system improvement. Sites varied in governance and decision rights concerning mortality review and adjudication, with 2 subthemes within organizational structures: (1) centralized-hierarchical and (2) decentralized or multidisciplinary. The analysis of mental models of participating reviewers revealed 2 themes: (1) confirmation of preventability and (2) identification of patterns or “signals.”

Conclusion

Understanding the factors that influence mortality review allows health systems to better leverage mortality review for institutional improvement and to develop training that builds shared mental models to enhance the review process.

组织意图、组织结构和审稿人心理模型影响死亡率审查过程
目的确定影响卫生系统死亡率审查过程的因素,包括死亡率审查的方式、案件的裁决和结果的使用。方法我们对2021年2月1日至2021年6月31日美国6个卫生系统的死亡率审查过程进行了定性分析。数据来源包括对死亡率审查小组成员的个人和小组半结构化访谈,以及对现场人工制品的内容分析(如指导原则、图表抽象形式、审查工作流程和从过去的死亡率审查中开发的临床途径)。我们分析了每个站点的死亡率审查过程、死亡率审查的目标和激励措施、死亡率审查历史和发展方面、参与人员以及审查后结果的使用。结果在6个系统中,我们共采访了24名死亡率审查专家,并分析了26份现场文件。我们确定了影响死亡率审查过程的3个主题因素:组织意图、死亡率审查的组织结构以及参与审查过程的个人的心理模型。在组织意图中出现了两个子主题:(1)确定可预防的死亡以降低(临床或财务)风险;(2)利用死亡病例指导系统改进。有关死亡率审查和裁决的治理和决策权各不相同,在组织结构中有两个子主题:(1)集中的层级和(2)分散或多学科。对参与评审的精神模型的分析揭示了两个主题:(1)可预防性的确认和(2)模式或“信号”的识别。“结论了解影响死亡率审查的因素可以使卫生系统更好地利用死亡率审查来改善制度,并开发建立共享心理模型的培训,以加强审查过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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