论文标题：Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

期刊： Frontiers of Medicine

作者：Longxiang Su, Xudong Ma, Sifa Gao, Zhi Yin, Yujie Chen, Wenhu Wang, Huaiwu He, Wei Du, Yaoda Hu, Dandan Ma, Feng Zhang, Wen Zhu, Xiaoyang Meng, Guoqiang Sun, Lian Ma, Huizhen Jiang, Guangliang Shan, Dawei Liu, Xiang Zhou, on behalf of China-NCCQC

发表时间：15 Aug 2023

DOI：10.1007/s11684-022-0970-x

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导 读

北京协和医院周翔、刘大为、单广良等在Frontiers of Medicine发表研究论文《重症监护病房（ICU）评估与质量控制指标权重：基于2015–2020年中国ICU质量数据的探索性研究》（Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020）。本研究基于2015-2020年中国3425家医院的ICU质量数据，通过探索性因子分析将15项质量控制指标提炼为6个核心要素，并构建了质量评分系统，为优化ICU质量控制指标体系提供了科学依据。

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015−2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ≥15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%×nosocomial infection management + 17.97%×compliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

本研究旨在探索2015–2020年中国大陆地区影响重症监护病房（ICU）患者预后的关键质量控制要素。数据来源于31家省市级医院（3425个ICU单元）的2 110 685例ICU患者，总计27 607 376个ICU住院日。研究发现，15项初始设立的质量控制指标对患者预后具有良好的预测效能，包括：ICU患者占全院住院患者比例（%）、ICU床位使用占全院床位使用比例（%）、ICU住院患者中急性生理与慢性健康评分II（APACHE II）≥15分者占比（%）、3小时（脓毒症救治指南）集束化治疗依从率（%）、6小时集束化治疗依从率（%）、抗生素使用前微生物送检率（%）、药物性深静脉血栓（DVT）预防措施落实率（%）、非计划性气管插管拔管率（%）、48小时内再插管率（%）、非计划性转入ICU率（%）、48小时ICU再入院率（%）、呼吸机相关性肺炎（VAP）（每1000呼吸机日）、导管相关性血流感染（CRBSI）（每1000导管日）、导尿管相关性尿路感染（CAUTI）（每1000导管日）、住院死亡率（%）。经探索性因子分析，上述15项指标被划分为6项权重差异化的质量评价核心要素：医院感染管理（21.35%）、脓毒症救治指南依从性（17.97%）、ICU资源配置（17.46%）、气道管理（15.53%）、深静脉血栓预防（14.07%）及患者病情危重程度（13.61%）。基于15项指标关联的6项核心要素权重，本研究构建了一个综合质量评分体系，定义为F评分=21.35%×医院感染管理 + 17.97%×脓毒症救治指南依从性 + 17.46%×ICU资源配置 + 15.53%×气道管理 + 14.07%×深静脉血栓预防 + 13.61%×患者病情危重程度。该循证质量评分体系将有助于评估质量管理核心要素，并为后续优化质量控制指标体系奠定基础。

期刊介绍

Frontiers of Medicine专注于发表临床医学和基础医学领域的最新研究成果，旨在通过全球医疗专业人员之间的交流促进健康和医疗保健的发展。该刊采用严格的同行评审和编辑流程，确保发表的文章的科学准确性、新颖性和重要性。

原文信息

标题

Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

作者

Longxiang Su¹, Xudong Ma², Sifa Gao², Zhi Yin³, Yujie Chen¹, Wenhu Wang³, Huaiwu He¹, Wei Du¹, Yaoda Hu⁴, Dandan Ma⁵, Feng Zhang⁵, Wen Zhu⁵, Xiaoyang Meng⁵, Guoqiang Sun⁵, Lian Ma⁵, Huizhen Jiang⁵, Guangliang Shan⁴, Dawei Liu¹, Xiang Zhou^1,5, on behalf of China-NCCQC¹

机构

1. Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China

2. Department of Medical Administration, National Health Commission of the People’s Republic of China, Beijing 100044, China

3. Intensive Care Unit, The People’s Hospital of Zizhong, Neijiang 641000, China

4. Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing 100730, China

5. Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

通讯作者

Guangliang Shan, Dawei Liu, Xiang Zhou

引用这篇文章

Longxiang Su, Xudong Ma, Sifa Gao, Zhi Yin, Yujie Chen, Wenhu Wang, Huaiwu He, Wei Du, Yaoda Hu, Dandan Ma, Feng Zhang, Wen Zhu, Xiaoyang Meng, Guoqiang Sun, Lian Ma, Huizhen Jiang, Guangliang Shan, Dawei Liu, Xiang Zhou, on behalf of China-NCCQC. Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020. Front. Med., 2023, 17(4): 675–684 https://doi.org/10.1007/s11684-022-0970-x

https://journal.hep.com.cn/fmd/EN/10.1007/s11684-022-0970-x

https://link.springer.com/article/10.1007/s11684-022-0970-x

感谢作者对Frontiers of Medicine的信任和支持。

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