QUALITY OF CARE IN ADULT HEART-SURGERY - PROPOSAL FOR A SELF-ASSESSMENT APPROACH BASED ON A FRENCH MULTICENTER STUDY

被引：49

作者：

ROQUES, F ^{[1
]}

GABRIELLE, F ^{[1
]}

MICHEL, P ^{[1
]}

DEVINCENTIIS, C ^{[1
]}

DAVID, M ^{[1
]}

BAUDET, E ^{[1
]}

机构：

[1] HOP HAUT LEVEQUE,CARDIAC SURG RISK ASSESSMENT STUDY GRP,BORDEAUX,FRANCE

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1995年 / 9卷 / 08期

关键词：

RISK ASSESSMENT; RISK STRATIFICATION; OPEN HEART SURGERY; QUALITY OF CARE; OPERATIVE MORTALITY;

D O I：

10.1016/S1010-7940(05)80078-8

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

A prospective study was carried out from January to April 1993 in 42 centers to assess the quality of care in adult heart surgery in France. One hundred eight parameters were collected (i.e., risk factors, surgery, postoperative course) for 7181 patients. Eight simple, objective factors were selected using a multivariate analysis. Point weighting was assigned to each factor. A simple cumulative score was thereby established to classify patients within four incremental risk groups (respective distribution of patients and mortality were 38.6%, 26.5%, 21.3%, 13.5% and 2%, 3.9%, 6.1%, 21.4%). This score was highly predictive for mortality and severe morbidity. Objectivity and independence of the observer, coupled with a reliable score, are needed for meaningful assessment of the quality of care. Administrative supervision and/or comparison of raw center results therefore remain controversial. A national data base was developed as a part of this study, that includes anonymous information from two-thirds of all cardiac surgery cases. Nation-wide results for France allow each center freely to assess its results. This self-assessment approach is, in our view, the most accurate way of quality of care assessment. A pan-European system using a similar approach should be developed.

引用

页码：433 / 440

页数：8

共 17 条

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