Appraising Hospital Performance by Using the JCHAOCMS Quality Measures in Southern Italy 英文参考文献.docVIP

AppraisingHospitalPerformancebyUsingtheJCHAO/ CMSQualityMeasuresinSouthernItaly DomenicoFlotta,PaoloRizza,PierluigiCoscarelli,ClaudiaPileggi,CarmeloG.A.Nobile,MariaPavia* DepartmentofHealthSciences,UniversityofCatanzaro‘MagnaGr?cia’,Catanzaro,Italy Abstract Objectives:Themainobjectiveofthepresentstudywastoestimatetheuptaketoqualityindicatorsthatreflectthecurrent evidence-basedrecommendationsandguidelines. Methods: A retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequencyormedianwascalculated,asappropriate,foreachindicator.Acompositescorewascalculatedtoestimatethe overallperformanceforeachareaofcare. Results:Atotalof1772medicalrecordswerereviewed.Theadherenceratesshowedawide-rangingvariabilityamongthe selectedindicators.Theuseofaspirinandangiotensin-convertingenzymeinhibitor(ACEI)orangiotensinreceptorblocker (ARB)forAMI,theuseofACEIorARBforHF,theuseofappropriatethromboembolismprophylaxisandappropriatehair removalforsurgicalpatientsalmostapproachedoptimaladherence.Attheotherextreme,ratesregardingadherenceto smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcalvaccinationinpneumoniapatientswerenoticeablyintangible.Overall,therecommendedprocessesofcare amongeligiblepatientswereprovidedin70%forAMI,in32.4%forHF,in46.4%forPN,andin46%forSCIP. Conclusions: The results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specificconditions,especially