慢性心力衰竭治疗质量指标体系的建立

Quality indicators for patients with chronic heart failure

目的 建立一套适合中国慢性心力衰竭治疗质量评价的指标体系,为下一步慢性心衰治疗质量评价提供量化工具.方法 检索PubMed、EMBASE等数据库,同时参考〈慢性心力衰竭诊断治疗指南〉筛选出候选指标.选择来自北京、上海、哈尔滨的15名专家组成专家组.应用德尔菲法咨询专家意见,根据专家打分的均数和选择率确定最终的指标体系.纳入标准为：均数≥3.5,选择率≥50.0%.结果 发放专家咨询表15份,专家积极系数为100%,每份均符合要求.经过三轮Delphi,由最初52个候选指标筛选出22个指标,构成慢性心衰治疗质量评价的指标体系,包括2个结构指标,18个过程指标（15个院内指标,3个出院指标）,2个结局指标.指标体系中,均数〉4分的有12个,选择率≥80.0%的9个.利尿剂的均数和选择率最大,分别为4.7和100%;院内感染率≤7%的均数和选择率最小,分别为3.5和53.3%.指标均数的范围为3.5~4.7,选择率的范围为53.3%~100.0%.结论 本研究建立的慢性心力衰竭治疗质量评价指标体系与国外相关组织建立的稍有不同,符合我国国情,能全面客观的评价慢性心衰的治疗质量,发现其中的不足,以促进我国慢性心衰治疗质量的改善.

Objective To develop quality indicators for patients with chronic heart failure in China, which would be used for assessing the quality of care. Methods Search databases such as PubMed. EMBASE and refer to the diagnosis and treatment guidelines of chronic heart failure to screen the candidate indicators. The panel consisted of 15 experts who came from Beijing, Shanghai and Harbin. Survey of experts＇ views was conducted with modified Delphi. Apply SAS 9.1.3 to calculate the mean and sdectance of the candidate indicators. The inclusion criteria is： mean must be greater than or equal to 3.5, selectance must be greater than or equal to 50.0%. Results All the advisory tables were regained. Positive coefficient of experts was 100%. The 22 of 52 candidate indicators were chosen, which included 2 outcome indicators, 18 process of care indicators （in- cluding 15 indicators at admission and 3 indicators at discharge）, and 2 structure indicators. There were 12 indicators＇ mean greater than 4, and 9 indicators＇ selectanee greater than or equal to 80.0%. Among them, diuretics had highest mean and select- ance, in contrast, nosocomial infection ≤7% had lowest mean and selectance. The range of 22 indicators＇ mean was from 3.5 to 4.7, and the range of selectance was from 53.3% to 100.0%. Conclusion The developed indicators that are appropriate for Chinese patients are slightly different from other organizations, which can comprehensively and objectively evaluate the quality of care and find problems in treatment, and will be used for improving the quality of care of chronic heart failure.