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Effect of institutional volume and academic status on outcomes of coronary interventions: The IMPACT-II experience

AMERICAN HEART JOURNAL 1999年第5期138卷 976-982页

作者： Gilchrist, IC Gardner, LH Muhlestein, JB Arnold, AM Lincoff, AM Califf, RM Tcheng, JE Topol, EJ Penn State Univ Milton S Hershey Med Ctr Hershey PA 17033 USA Duke Univ Clin Res Inst Durham NC 27706 USA St Lukes Med Ctr Salt Lake City UT USA Cleveland Clin Fdn Cleveland OH 44195 USA

Background Rates of morbidity and mortality after interventional procedures are reported to be inversely associated with institutional volume. Methods This study assessed both procedural volume and academic status at the 82 US centers that participated in the IMPACT-II trial. Interventional volumes at the sites ranged from 90 to 3300 cases per year. Patients were randomly assigned to a platelet glycoprotein IIb/IIIa inhibitor (eptifibatide) or placebo during procedures done by experienced operators. The primary end point was the composite of death, myocardial infarction, nonelective repeat coronary intervention, or nonelective coronary artery bypass surgery at 80 days, or placement of an intracoronary stent for abrupt closure during the initial procedure. Results Baseline patient characteristics and median length of stay were similar between the academic and nonacademic centers. In univariable analysis, volume as a continuous variable had a nonlinear relation with the incidence of the composite end point, with better outcomes noted at the highest volume institutions. Academic status did not predict outcome. When added to a predictive model that contained the variables unstable angina,weight, prior coronary artery bypass grafting, heart rate, and platelet count, procedural volume continued to be associated with the composite outcome (P = .04). Conclusions We conclude that among hospitals participating in this trial, there is a nonlinear relation between annual interventional volume and outcomes. This relation is complex, involving variations in periprocedural infarction rates and additional, undefined institutional differences (other than academic status) that result in differences in procedural outcome.

关键词：医学科学研究中心/标准医学科学研究中心/统计学和数值数据心绞痛不稳定型/药物疗法心绞痛不稳定型/死亡率随访研究医院大学/标准医院大学/统计学和数值数据住院时间多机构系统/标准多机构系统/统计学和数值数据结果评价(卫生保健) 肽类/治疗应用血小板聚集抑制剂/治疗应用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂回顾性研究存活率美国/流行病学老年人女(雌)性人类男(雄)性中年人

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Developing a hospital policy for clinical pathways.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1995年第6期17卷 40-51页

作者： Sprouse, M.W. Whitmore, B.C. Columbia/HCA Healthcare Corp. Nashville TN United States

Clinical pathways are used for planning, coordinating and facilitating the continuum of patient care from before admission to after discharge. They rapidly are changing the provision of healthcare services through improved patient care and cost containment, but they also have raised questions about possible legal ramifications. If sound policies and procedures for clinical pathways are developed and consistently adhered to by healthcare facilities, the potential for liability may be minimized while patient care is improved. This article describes a multidisciplinary task force's work to develop such policies and procedures.

关键词：机密临床路径/立法和法学临床路径/标准文献工作表格和记录管理指导方针(主题) 医院私营/立法和法学医院私营/组织和管理医院私营/标准责任法律病案多机构系统/立法和法学多机构系统/组织和管理多机构系统/标准组织方针医师诊疗模式规划制订危险处理/立法和法学美国

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A database to select and inventory services, measure value, and assist redesign.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1996年第5期18卷 12-20页

作者： Tracy, D.M. Jacobson, J.T. Salt Lake Valley Hospitals Salt Lake City UT United States

The services of a three-hospital quality resource department (QRD) were redesigned over a 5-year period. The intention was to provide high-level database management services to improve hospital operations and ensure accountability for performance. There were three key components to the redesign efforts: planning, learning, and measuring performance. This article focuses on planning and measuring the QRD's service using a project registry database.

关键词：卫生保健公平提供/组织和管理医院信息系统/组织和管理医院信息系统/标准医院计划医院改组医院社区医院教学多机构系统/组织和管理多机构系统/标准组织目标全面质量管理犹他

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Implementing the 10 step QA model in a state psychiatric multi-hospital system.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1989年第4期11卷 12-13,37页

作者： Ehrhart, K. Mental Health Programs Department of Human Services State of Minnesota

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Benchmarking and networking through collaborative groups.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1996年第1期18.0卷 26-31页

作者： Hodges, R. Kelley, L. Wilkes, A. SunHealth Alliance Inc. Charlotte NC United States

The search for better ways to deliver healthcare services at lower cost led a group of hospitals in the Carolinas, 2 years ago, to pioneer a new concept, the collaborative group. A collaborative group typically is composed of five or six similar (but not competing) hospitals that work together closely to help each other make the changes necessary to survive in an increasingly competitive marketplace. Hospital staff members at all levels are able to work together to discover improvement opportunities through benchmarking teams and networking efforts. This article describes their experiences, achievements, and lessons learned.

关键词：效率组织/标准集中研讨小组团体处理医院管理人员/组织和管理机构管理小组/组织和管理机构间关系模型组织管理多机构系统/经济学多机构系统/组织和管理多机构系统/标准北卡罗来纳组织改革组织目标同侪集群南卡罗来纳人类

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Comparative data analysis using collaborative skilled nursing/long-term care indicator assessment.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第4期20卷 12-20页

作者： Denny, D.S. Christian, V. Nordan, V.N. Therriault, M.F. Catholic Health East United States

This article describes a process developed by Eastern Mercy Health System (EMHS), headquartered in Radnor, PA, to identify opportunities for quality improvement using defined outcome-based indicators in skilled nursing and long-term care (SN/LTC). The model is built on collaboration among the system's freestanding and hospital-based facilities;it includes a cyclical approach to the exchange of information. The experiences of three of the system's members reflect how each has realized measurable benefits by applying to their unique settings the lessons learned through the collaborative process.

关键词：意外跌倒/预防和控制亚拉巴马天主教教育继续长期医疗/标准管理质量小组多机构系统/组织和管理多机构系统/标准纽约组织状况研究结果评价(卫生保健) 宾夕法尼亚精神治疗药物/治疗应用质量指标卫生保健约束身体的技术性护理设施/组织和管理技术性护理设施/标准亚急性期医疗护理/标准美国人类

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Teaching total quality management: developing and deploying education throughout a healthcare system.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1997年第2期19卷 17-23,26页

作者： Kleeb, T.E. Omaha Veterans Administration Medical Center NE USA.

Healthcare organizations are faced with the responsibility of teaching their entire staff the founding principles, concepts, and practices of total quality management (TQM), to improve organizational effectiveness. Purchasing training products from outside consultants can be costly, but healthcare leaders can design and develop their own TQM training products, integrating each product with their organization's mission and values. This article describes how a Catholic healthcare system successfully developed and deployed a compendium of TQM educational products throughout the health-care system.

关键词：天主教成本及成本分析卫生人员/教育医院宗教/组织和管理医院宗教/标准在职培训/组织和管理模型教育模型组织管理多机构系统/组织和管理多机构系统/标准组织文化软件设计教材全面质量管理/方法美国人类

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Quality management in a multi-hospital system: a single standard of care.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1990年第1期12卷 22-23,39页

作者： Allen, R.H. Dambro, M.R. Harris Methodist Health System Fort Worth TX.

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Patients leaving against medical advice: assessing the liability risk.

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Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management 1993年第1期13卷 19-22页

作者： Quinlan, W.C. Majoros, N. Western Reserve Care System Youngstown OH United States

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The quality assurance program at Affiliated Hospitals of Indiana, Inc.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1991年第1期13卷 20-21页

作者： Barger, D. French, J. Affiliated Hospitals of Indiana.

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