中国冠状动脉旁路移植术医疗质量控制工作报告

Healthcare Quality and Performance Improvement for Coronary Artery Bypass Grafting in China

冠状动脉旁路移植术(CABG)是冠心病的主要治疗手段。然而,我国不同地区和医院冠状动脉外科的不均衡发展与冠心病疾病负担的日益加剧形成突出矛盾,医疗质量亟待改善。国家心血管病医疗质量控制中心专家委员会心外科专家工作组致力于全国CABG的质量评价与改善工作。基于中国心外科注册登记系统(CCSR)数据,工作组描述了近年我国区域代表性心外科中心CABG质量现状。2016~2018年,我国CABG患者整体手术危险因素占比增高,手术风险增大,但各单位CABG手术诊疗规范性呈改善趋势,乳内动脉桥使用率和二级预防药物使用率整体升高,同时,医院之间诊疗差异逐步缩小,不同单位手术技术使用率差异降低。此外,医院CABG后死亡率和并发症发生率呈下降趋势,同时医院之间的离散程度缩小。尽管近年数据展示我国CABG医疗质量呈现改善趋势,但整体心外科技术水平与诊疗规范性仍有进一步提升空间,关键技术使用率仍显著低于欧美国家,同时医院之间的诊疗质量差异始终显著,需要未来持续进行质量改善。该数据明确展示了真实世界CABG诊疗过程中的具体质量问题,为下一步质量改善工作提供了靶点和方向。

Coronary artery bypass grafting(CABG)is one of the most important options for the treatment for coronary heart disease.Despite the increasing burden of coronary heart disease,the development of CABG in different regions and hospitals in China is uneven,and the quality of medical care needs to be improved.The Cardiac Surgery Working Group of National Center for Quality Control of Cardiovascular Diseases is committed to the performance measurement and improvement for CABG in China,and has taken multiple measures including the development of the expert committee,the development of key performance measures,and the establishment of healthcare quality database.Based on the data of the Chinese Cardiac Surgery Registry(CCSR),the working group describes the recent performance of CABG in the regional representative cardiac surgery centers in China.From 2016 to 2018,the median hospital-level rates of the use of internal mammary artery(IMA)graft and secondary preventive medications increased over time.The heterogeneity in the practice among the hospitals has gradually reduced,and the difference in the rates of the use of surgical techniques among different units has decreased.Hospital-level postoperative mortality and complication rates also showed a downward trend,while the differences in surgical outcomes between hospitals decreased.Although the data in recent years has showed a trend of improvement for the healthcare quality of CABG in China,there is still room for further improvement in the surgical practice and patient outcomes.For example,the use of IMA graft and secondary preventive medications is still significantly lower than that in European and American countries,which warrants continuous quality improvement in the future.The data clearly shows the specific quality problems for CABG in the real world,and provides targets and directions for the next step of quality improvement.