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Practical risk-adjusted quality control charts for infection control

AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 406-414页

作者： Gustafson, TL Infect Control & Prevent Analysts Inc Austin TX 78735 USA

Background: Control chart methodology has been widely touted for monitoring and improving quality in the health care setting. P charts and U charts are frequently recommended for rate and ratio statistics, but their practical value in infection control may be limited because they (1) are not risk-adjusted, and (2) perform poorly with small denominators. The Standardized Infection Ratio is a statistic that overcomes both these obstacles. It is risk-adjusted, and it effectively increases denominators by combining data from multiple risk strata into a single value. Setting: The AICE National Database Initiative is a voluntary consortium of US hospitals ranging in size from 50 to 900 beds. The infection control professional submits monthly risk-stratified data for surgical site infections, ventilator-associated pneumonia, and central line-associated bacteremia. Methods: Run charts were constructed for 51 hospitals submitting data between 1996 and 1998. Traditional hypothesis tests (P values < .05) flagged 128 suspicious points, and participating infection control professionals investigated and categorized each flag as a "real problem" or "background variation." This gold standard was used to compare the performance of 5 unadjusted and 11 risk-adjusted control charts. Results: Unadjusted control charts (C, P, and U charts) performed poorly. Flags based on traditional 3-sigma limits suffered From sensitivity < 50%, whereas 2-sigma limits suffered from specificity < 50%. Risk-adjusted charts based on the Standardized Infection Ratio performed much better The most consistent and useful control chart was the mXmR chart. Under optimal conditions, this chart achieved a sensitivity and specificity > 80%, and a receiver operating characteristic area of 0.84 (P < .00001). Conclusions: These findings suggest a specific statistic (the Standardized Infection Ratio) and specific techniques that could make control charts valuable and practical tools for infection control.

关键词：菌血症/流行病学菌血症/病因学偏倚(流行病学) 交叉感染/流行病学交叉感染/病因学数据说明统计数据库事实型表格和记录管理/标准指导方针(主题) 医院病床数感染控制/组织和管理信息管理/标准病案/标准肺炎/流行病学肺炎/病因学质量控制问卷调查风险调节/组织和管理敏感性与特异性外科伤口感染/流行病学外科伤口感染/病因学美国/流行病学人类

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A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario

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AMERICAN HEART JOURNAL 2002年第2期144卷 290-296页

作者： Austin, PC Daly, PA Tu, JV Inst Clin Evaluat Sci Toronto ON M4N 3M5 Canada Univ Toronto Dept Publ Hlth Sci Toronto ON Canada Sunnybrook & Womens Coll Site Clin Epidemiol & Hlth Care Res Program Toronto ON Canada Sunnybrook & Womens Coll Ctr Hlth Sci Dept Med Div Gen Internal Med Toronto ON Canada Toronto Gen Hosp Dept Med Div Cardiol Toronto ON M5G 1L7 Canada

Background Cardiac health services researchers frequently use cohorts derived from administrative hospital discharge abstract data to study the outcomes and treatment of coronary artery disease. However, relatively limited data exist on the accuracy of the coding of cardiac diagnoses in discharge abstract data. The goal of this study was to examine the accuracy of the coding of acute myocardial infarction and other cardiac diagnoses in the Canadian Institute of Health Information hospital discharge abstracts. Methods Patients admitted to 58 cardiac care units (CCUs) in Ontario that participated in the Fastrak 11 Acute Coronary Syndromes registry were linked to CIHI hospital discharge abstracts. The most responsible diagnosis at hospital discharge in the administrative data was compared with the CCU discharge diagnosis in the clinical registry. Results A total of 58,816 CCU patients were linked to hospital discharge abstract data. The specificity, sensitivity, and positive predictive value of a most responsible diagnosis of acute myocardial infarction were 92.8%, 88.8%, and 88.5%, respectively. The specificity of CIHI diagnosis codes for arrhythmia, congestive heart failure, unstable angina, and chest pain not yet diagnosed were all at least 93.9%. However, the sensitivity of these CIHI diagnosis codes was no greater than 60.7%. Furthermore, the positive predictive values were no larger than 80.8%. Conclusion Myocardial infarction is generally accurately coded in Ontario hospital discharge abstract data. However, other cardiac diagnoses are less reliably coded in discharge abstract data.

关键词：心绞痛不稳定型/分类心绞痛不稳定型/诊断胸痛/病因学冠心病重症监护病房/组织和管理冠心病重症监护病房/利用冠心病/分类冠心病/诊断诊断相关患者组/分类表格和记录管理/标准病案连锁心肌梗死/分类心肌梗死/诊断安大略病人出院/标准病人出院/统计学和数值数据试验预期值登记/统计学和数值数据敏感性与特异性老年人女(雌)性人类男(雄)性

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Improving the quality of medical record documentation.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1992年第3期14卷 16-23页

作者： Martin, C.A. Coopers & Lybrand Albany NY

Accurate and complete medical record documentation is essential in any healthcare setting. In addition to communicating vital patient care information, the medical record provides documentation of appropriate evaluation, treatment, and services. It also is used to evaluate practitioner performance, to monitor resource use, and to determine reimbursement. In this article, Carol Ann Martin describes the efforts of one hospital to revise and upgrade its medical record documentation by means of continuous quality improvement strategies.

关键词：信息交流文献工作/标准表格和记录管理/方法表格和记录管理/标准医院病床数 300至499张部门间关系马萨诸塞病案/标准医务人员医院模型理论护理人员医院组织目标专家委员会/组织和管理质量保证卫生保健/组织和管理系统分析

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Complying with changes in OSHA's recordkeeping requirements. An overview.

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AAOHN journal : official journal of the American Association of Occupational Health Nurses 2002年第7期50卷 324-333;quiz334-335页

作者： Klamert, Patricia Coleen University of Michigan-MWorks Occupational Health Services Ann Arbor MI United States

Understanding and complying with the new record-keeping rule may be challenging. However, complying with the new rule is the way to improve and maintain the health and safety of employees through implementation of pri... 详细信息

关键词：表格和记录管理/标准坚持准则/标准美国美国职业安全和卫生署/标准人类

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Complying with Joint Commission nursing standards: practical documentation tools.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1992年第1期14卷 24-29页

作者： Miller, D.H. Carl T. Hayden VA Medical Center Phoenix AZ United States

The need for accurate and complete documentation of nursing care has grown as hospitals seek to comply with the new requirements of the Joint Commission on Accreditation of Healthcare Organizations. As of January 1991, the Joint Commission implemented standards for nursing services that include documentation of the planning and delivery of nursing care. While the new JCAHO standards do not call for a separate nursing care plan, they nevertheless involve enough changes to require modification of most currently used documentation forms. This article describes the methods used to design new forms at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix, AZ. The newly developed forms are reviewed and compared with the Joint Commission's new standards and scoring guidelines.

关键词：亚利桑那文献工作/标准表格和记录管理/标准医院病床数 300至499张医院退伍军人/组织和管理医院退伍军人/标准卫生保健组织鉴定联合委员会病案/标准护理估计护理记录/标准护理部医院/标准病人入院病人医疗护理计划/标准病人出院/标准质量保证卫生保健/组织和管理美国

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Jim Maddux--an author of OSHA's new recordkeeping rule. Interview by Eileen Lukes.

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AAOHN journal : official journal of the American Association of Occupational Health Nurses 2002年第7期50卷 297-298页

作者： Maddux, Jim

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NHS records: past, present and future.

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Health libraries review 1998年第4期15卷 279-280页

作者： Wishart, L. Information Management Branch Department of Health London United Kingdom

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Mastering the Ambulatory Patient Groups system.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1998年第1期20卷 29-31,41页

作者： Poto-Dill, E. OCRR Inc. United States

Providers and payers will need to implement the Ambulatory Patient Groups (APG) system, a complex new payment mechanism for outpatient care. Because the APG system consolidates, packages, and discounts a facility's payment for outpatient services, providers might receive decreased reimbursement for services, as compared to the reimbursement received under their present outpatient payment arrangements. APGs, like DRGs, will force providers to examine their coding practices carefully to ensure that they will receive reimbursement adequate to cover their costs.

关键词：门诊医疗/分类门诊医疗/经济学辅助服务医院/经济学诊断相关患者组/分类诊断相关患者组/经济学表格和记录管理/标准医院病床数 300至499张衣阿华 Medicaid 病案/分类病案/标准预期支付系统/分类美国

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Introduction of ICD-10-AM.

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Health information management : journal of the Health Information Management Association of Australia 1998年第1期28卷 32-33页

作者： Murray, J. Classification and Payments Branch Department of Health and Family Services

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A look back at over 50 years of NHS record keeping.

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Health libraries review 1998年第4期15卷 280-282页

作者： Marsh, M. Zeneca Pharmaceuticals Macclesfield Cheshire United Kingdom

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