扩大手术前评估诊所的作用:对风险和质量结果测量的影响。

Michael Smerina MD , Adrian G. Dumitrascu MD , Aaron C. Spaulding PhD , James W. Manz MD , Razvan M. Chirila MD
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引用次数: 0

摘要

目的:证明住院患者调整后的手术风险和质量结果指标会受到干预措施的显著影响,以改善术前评估(POE)诊所的文件记录。患者和方法:我们与POE诊所的多学科团队一起设计了一个质量改进项目,以通过改进文档更准确地反映手术风险并影响预期的手术质量结果。干预措施包括改进患者记录获取过程和广泛的POE提供者关于患者合并症文件的教育。对于计划手术后入院的患者,POE诊所综合评估记录与住院病史和身体记录相关联。2018年10月1日至2018年12月31日就诊的高复杂性患者为干预前队列,2019年1月1日到2019年12月30日就诊的患者为干预后队列。结果:主要结果指标包括每次就诊的编码诊断总数和每次就诊的分级疾病分类数。次要结果包括计算的疾病严重程度、死亡风险、病例组合指数和风险调整因素。干预后的结果显示,前列腺癌的所有主要结果在统计学上都有显著增加。结论:我们的干预证实,全面的POE和彻底的文献记录可以更准确地描述术前患者的临床情况,这反过来又会影响住院手术环境中的质量结果。这些结果对直接和间接的患者护理以及公开报告的医院和提供者级别的绩效数据都有影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Expanding the Role of the Surgical Preoperative Evaluation Clinic: Impact on Risk and Quality Outcome Measures

Expanding the Role of the Surgical Preoperative Evaluation Clinic: Impact on Risk and Quality Outcome Measures

Objective

To prove that inpatient-adjusted surgical risk and quality outcome measures can be considerably impacted by interventions to improve documentation in the preoperative evaluation (POE) clinic.

Patients and Methods

We designed a quality improvement project with a multidisciplinary team in our POE clinic to more accurately reflect surgical risk and impact expected surgical quality outcomes through improved documentation. Interventions included an improved patient record acquisition process and extensive POE provider education regarding patient comorbidities’ documentation. For patients admitted after their planned operations, POE clinic comprehensive evaluation notes were linked to inpatient History and Physical notes. High complexity patients seen from October 1, 2018 to December 31, 2018 were the preintervention cohort, and the patients seen from January 1, 2019 to December 31, 2019 were the postintervention cohort.

Results

The primary outcome measures included the total number of coded diagnoses per encounter and the number of coded hierarchical condition categories per encounter. The secondary outcomes included the calculated severity of illness, risk of mortality, case-mix index, and risk-adjustment factor. Postintervention results show statistically significant increases in all primary outcomes with a P<.05. All secondary outcome measures reported positive change.

Conclusion

Our interventions confirm that a comprehensive POE and thorough documentation provide a more accurate clinical depiction of the preoperative patient, which in turn impacts quality outcomes in inpatient surgical settings. These results are impactful for direct and indirect patient care and publicly reported hospital and provider level performance data.

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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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