《中国医院质量安全管理》团体标准应用对手术质量的影响:以结肠手术为例

The Effect of"Chinese Hospital Quality and Safety Management"Group Standards Application on Operation Quality:Taking Colon Surgery as an Example

目的以《中国医院质量安全管理第4-8部分:医疗管理医院感染管理》对于结肠手术的影响为例,评估《中国医院质量安全管理》团体标准应用对于外科手术服务质量的影响及其实施效果。方法以医院信息系统为依托,分别提取2018年10月1日-2019年9月30日(标准实施前)与2019年10月1日-2020年9月30日(标准实施后)结肠手术患者数据,分析与比较患者年龄、共病等基础特征,并采用间断性时间序列分析(ITSA),评估标准实施对于不良事件、住院时长的影响。结果研究共纳入4442例结肠手术患者,其中标准实施前的患者为2936例,实施后的患者为1506例。单因素分析显示,与标准实施前相比,标准实施后的结肠手术患者共病指数较高(2.25±4.95 vs 3.95±6.14,P<0.0001),恶性肿瘤患病率较高(14.03%vs 26.10%,P<0.0001),平均住院日增加(10.95±8.52 vs 13.29±9.50,P<0.0001),但不良事件发生率并未提高(1.12%vs 0.86%,P=0.4164)。ITSA显示,标准实施后,不良事件发生率与住院时长均无显著增加。结论医院质量安全管理标准的实施可在一定程度上应对患者病情的加重对于临床结局造成的负面影响,保障医疗服务的质量安全。

Objective Taking the impact of"China Hospital Quality and Safety Management Part 4-8:Medical Management,Hospital Infection Management"on colon surgery as an example,to evaluate the effect of the application of"Chinese Hospital Quality and Safety Management"group standards on surgical operation service.Methods Based on the hospital information system,colon surgery inpatients data were extracted from October 1,2018 to September 30,2019(before the implementation of the group standards)and from October 1,2019 to September 30,2020(after the implementation of the group standards).Baseline characteristics such as age and comorbidities were analyzed and compared,and interrupted time series analysis(ITSA)was used to evaluate the impact of standard implementation on adverse events and length of hospital stay.Results A total of 4442 colon surgery inpatients were included in the study,with 2936 patients before the implementation of the group standards and 1506 patients after the implementation.Compared with periods before the implementation of the group standards,patients after the implementation had higher comorbidity index(2.25±4.95 vs 3.95±6.14,P<0.0001),higher prevalence of malignant tumor(14.03%vs 26.10%,P<0.0001)and longer length of hospital stay(10.95±8.52 vs 13.29±9.50,P<0.0001),but there was no increase in the incidence of adverse events(1.12%vs 0.86%,P=0.4164).ITSA showed that there was no significant increase in the incidence of adverse events and length of stay after the implementation of group standards.Conclusion The implementation of hospital quality and safety management standards can deal with the negative impact of worse patient conditions on clinical outcomes,ensuring the quality and safety of medical services,to some extent.