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[1]刘皓冉魏粤晖简伟研.国内外重症监护单元医疗质量指标比较研究[J].中国卫生质量管理,2024,31(05):22-28.[doi:10.13912/j.cnki.chqm.2024.31.5.06]
　LIU Haoran,WEI Yuehui,JIAN Weiyan.A Comparative Study of Medical Quality Indicators in ICU in China and Abroad[J].Chinese Health Quality Management,2024,31(05):22-28.[doi:10.13912/j.cnki.chqm.2024.31.5.06]

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国内外重症监护单元医疗质量指标比较研究

《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R] 卷: 第31卷期数: 2024年05期页码: 22-28 栏目: 医疗质量出版日期: 2024-05-15

Title:: A Comparative Study of Medical Quality Indicators in ICU in China and Abroad

作者:: 刘皓冉魏粤晖简伟研; 北京大学公共卫生学院

Author(s):: LIU Haoran; WEI Yuehui; JIAN Weiyan; School of Public Health, Peking University

关键词:: 症监护单元（ICU）; 医疗质量; 指标; 评价; 重症医学

Keywords:: Intensive Care Unit (ICU); Medical Quality; Indicators; Evaluation; Critical Care Medicine

分类号:: R197

DOI:: 10.13912/j.cnki.chqm.2024.31.5.06

文献标志码:: A

摘要:: 目的通过系统梳理国内外重症监护单元（ICU）医疗质量指标，并进行比较分析，为我国ICU医疗质量评价提供参考。方法政策梳理与文献回顾法。结果ICU医疗质量指标开发包括相关组织或部门制定和研究学者自行拟定。过程指标和结果指标是国内外普遍关注的指标，特别是三大感染率和死亡率相关指标；结构指标的关注情况存在差异。ICU医疗质量指标相关研究多为应用研究，缺少评价研究。结论为提升我国ICU医疗质量，应统一指标制订的理论依据和分类标准，拓宽指标类别，提高测量精度，落实指标培训工作，建立动态管理机制，并定期优化指标体系。

Abstract:: ObjectiveTo systematically sort out medical quality indicators in intensive care unit (ICU) in China and abroad and conduct comparative analysis,so as to provide reference for the evaluation of ICU medical quality in China. MethodsPolicy review and literature review methods were used.ResultsThe development of ICU medical quality indicators included the formulation by relevant organizations or departments and the formulation by researchers themselves. Process indicators and outcome indicators were widely concerned, especially the three major indicators related to infection rate and mortality. There was difference in the attention paid to structural indicators. The research on ICU quality index was mostly applied research, but lack of evaluation research.Conclusion In order to improve the medical quality of ICU in China, it is necessary to unify the theoretical basis and classification criteria of indicators, broaden the categories of indicators, improve the measurement accuracy, implement index training, establish a dynamic management mechanism, and optimize the index system regularly.

参考文献/References:

［1］刘大为. 中国重症医学30年发展之路［J］. 中国实用内科杂志, 2011, 31(11): 835-837.［2］中华医学会重症医学分会.《中国重症加强治疗病房(ICU)建设与管理指南》(2006)［J］. 中国危重病急救医学, 2006,18(7): 387-388.［3］NQF. National Quality Forum ［EB/OL］. (2022-01-09)［2024-01-20］. https://www.qualityforum.org/Qps/QpsTo ol.asp.［4］HEALTHCARE NABFH. ICU checklist and quality indicators for NABH accreditation preparation ［EB/OL］. (2021-03-06)［2024-01-20］. https://relyhealthtech.com/readnews?id=105&ICU_checklist_and_quality_indicators_for_NABH_accreditation_preparation.［5］DE VOS M, GRAAFMANS W, KEESMAN E, et al. Quality measurement at intensive care units: which indicators should we use［J］. Journal of Critical Care, 2007, 22(4): 267-274.［6］VAN DER VOORT PH, VAN DER VEER SN, DE VOS ML. The use of indicators to improve the quality of intensive care: theoretical aspects and experiences from the dutch intensive care registry［J］. Acta Anaesthesiol Scand, 2012, 56(9): 1084-1091.［7］RAY B, SAMADDAR DP, TODI SK, et al. Quality indicators for ICU: ISCCM guidelines for ICUs in India［J］. Indian Journal of Critical Care Medicine, 2009, 13(4): 173-206.［8］RHODES A, MORENO RP, AZOULAY E, et al. Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)［J］. Intensive Care Medicine, 2012, 38(4): 598-605.［9］国家卫生计生委. 国家卫生计生委办公厅关于印发麻醉等6个专业质控指标（2015年版）的通知［EB/OL］. (2015-04-13)［2024-01-20］. http://www.nhc.gov.cn/yzygj/s7657/201504/5fa7461c3d044cb6a9 3eb6cc6eece087.shtml.［10］国家卫生健康委. 关于印发《三级医院评审标准（2022年版）》及其实施细则的通知：国卫医政发〔2022〕31号［EB/OL］. (2022-12-06)［2024-01-20］. http://www.gov.cn/zhengce/zhengceku/2022-12/18/content_5732583.htm.［11］马谢民. 国际医疗质量指标体系及其特点［J］. 中国医院管理, 2007, 27(11): 22-24.［12］梁铭会, 舒婷, 焦亚辉. 美国的国际医疗质量指标体系［J］. 中国医院, 2009, 13(4): 14-17.［13］马雯, 赵乐平, 马谢民. 国际主要医疗质量评价体系选择的临床指标及其共性［J］.中国医院管理, 2014, 34(8): 17-19.［14］BERENHOLTZ SM, DORMAN T, NGO K, et al. Qualitative review of intensive care unit quality indicators［J］. J Crit Care, 2002, 17(1): 1-12.［15］杨苏. 基于循证构建ICU护理质量敏感性指标的研究［D］.杭州: 浙江大学, 2016.［16］PARI V. Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries［J］. Intensive Care Medicine, 2022, 48(11): 1551-1562.［17］李增辉, 高嗣法, 马旭东, 等. 新重症医学医疗质量控制指标体系构建［J］. 中国卫生质量管理, 2022, 29(3): 26-29.［18］潘孝东, 刘宝, 周树生, 等. 2013～2015年安徽省重症医学科质量控制情况的横断面调查［J］. 中国循证医学杂志, 2018, 18(4): 298-305.［19］潘孝东. 2013-2015年安徽省重症医学科质量控制情况的横断面调查［D］. 合肥: 安徽医科大学, 2019.［20］罗丹华, 王彩芳, 谭琼英, 等. 质量管理系统在ICU护理敏感质量过程指标中的应用［J］. 护理学报, 2019, 26(12): 15-19.［21］FERRER R, ARTIGAS A, LEVY MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain［J］. JAMA, 2008, 299(19): 2294-2303.［22］BERWICK D, FOX DM. "Evaluating the quality of medical care": Donabedian’s classic article 50 years later［J］. Milbank Quarterly, 2016, 94(2): 237-241.［23］ZEGERS M, VERHAGE R, HES SELINK G, et al. Putting measurement on a diet: development of a core set of indicators for quality improvement in the ICU using a Delphi method［J］. BMC Health Services Research, 2022, 22(1): 869.［24］YANG S, HUANG LH, ZHAO XH, et al. Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China［J］. Research in Nursing and Health, 2019, 42(1): 48-60.［25］傅彩虹, 汤雪梅, 王冬丽, 等. ICU护理敏感指标在护理质量改进中的应用效果［J］. 甘肃医药, 2020, 39(1): 75-77.［26］CHIU WT, YANG CM, LIN HW, et al. Development and implementation of a nationwide health care quality indicator system in Taiwan［J］. International Journal for Quality in Health Care, 2007, 19(1): 21-28.［27］CHERNECKY C, MACKLIN D, BLACKBURN P. Catheter-Related Bloodstream Infections (CR-BSI) in geriatric patients in Intensive Care Units［J］. Critical Care Nursing Quarterly, 2015, 38(3): 280-292.［28］TYSON AF, CAMPBELL EF, SPANGLER LR, et al. Implementation of a nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a surgical trauma ICU［J］. J Intensive Care Med, 2020, 35(8): 738-744.［29］MULVEY HE, HASLAM RD, LAYTIN AD, et al. Unplanned ICU admission is associated with worse clinical outcomes in geriatric trauma patients［J］. Journal of Surgical Research, 2020, 245: 13-21.［30］DE JONGHE B, CONSTANTIN JM, CHANQUES G, et al. Physical restraint in mechanically ventilated ICU patients: a survey of French practice［J］. Intensive Care Medicine, 2013, 39(1): 31-37.［31］COYER F, GARDNER A, DOUBROVSKY A. An interventional skin care protocol (InSPiRE) to reduce incontinence-associated dermatitis in critically ill patients in the intensive care unit: A before and after study［J］. Intensive and Critical Care Nursing, 2017, 40: 1-10.［32］COMPTON F, HOFFMANN F, HORTIG T, et al. Pressure ulcer predictors in ICU patients: nursing skin assessment versus objective parameters［J］. Journal of Wound Care, 2008, 17(10): 417-420, 422-414.［33］LINKAIT G, RIAUKA M, BUNEVICIT I, et al. Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit［J］. Acta Med Litu, 2018, 25(1): 14-22.［34］李奇, 马旭东, 苏龙翔, 等. 全国重症医学专业医疗服务与质量安全调查［J］. 中国卫生质量管理, 2020, 27(1): 1-4，43.［35］白冬梅, 罗曼, 谢伦芳, 等. 护理敏感指标监测在ICU护理质量管理中的应用［J］. 蚌埠医学院学报, 2020, 45(6): 832-835，839.［36］杨丽娜, 戴茹, 刘甜, 等. 护理敏感质量指标在ICU护理质量持续改进中的应用［J］. 中国护理管理, 2018, 18(3): 407-410.［37］王新伟, 傅全威, 周俭平, 等. 某三甲医院重症医学医疗质量管理现状调查［J］. 创伤与急危重病医学, 2016, 4(5): 308-311.［38］丁留敏, 李丽, 张秀敏. 新疆地区三级甲等综合医院ICU质量控制指标的比较［J］. 解放军护理杂志, 2018, 35(24): 68-72.［39］周翔, 刘大为, 隆云, 等. 北京地区重症医学科质量控制现状调查的流行病学研究［J］. 中国医刊, 2013, 48(12): 31-33.［40］KAMDAR BB, KING LM, COLLOP NA, et al. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU［J］. Critical Care Medicine, 2013, 41(3): 800-809.［41］MISSET B, TIMSIT JF, DUMAY MF, et al. A continuous quality-improvement program reduces nosocomial infection rates in the ICU［J］. Intensive Care Medicine, 2004, 30(3): 395-400.［42］RANZANI OT, SIMPSON ES, AUGUSTO TB, et al. Evaluation of a minimal sedation protocol using ICU sedative consumption as a monitoring tool: a quality improvement multicenter project［J］. Critical Care (London, England), 2014, 18(5): 580.［43］DAMIANI LP, CAVALCANTI AB, MOREIRA FR, et al. A cluster-randomised trial of a multifaceted quality improvement intervention in Brazilian intensive care units (Checklist-ICU trial): statistical analysis plan［J］. Critical Care and Resuscitation, 2015, 17(2): 113-121.［44］WANG F, AVASARALA A, PANDYA N, et al. Impact of respiratory therapists-driven assess-and-treat protocol on unplanned adult neurovascular ICU readmissions: a quality improvement initiative［J］. BMJ Open Qual, 2022, 11(2)：001816.［45］周霞, 陈真真. 护理标识对急诊重症监护室护理质量的作用分析［J］. 当代医学, 2021, 27(18): 179-181.［46］韩聪, 刘宇飞. 急诊重症监护室运用护理标识对提高护理质量的影响分析［J］. 中外医疗, 2020, 39(16): 160-162.［47］张蕊. PDCA持续质量改进护理对重症监护室呼吸机相关性肺炎发生率的影响［J］. 中国民康医学, 2020, 32(20): 146-148.［48］BROWN SE, RATCLIFFE SJ, HALPERN SD. An empirical comparison of key statistical attributes among potential ICU quality indicators［J］. Crit Care Med,2014,42(8): 1821-1831.［49］DING X, MA X, GAO S, et al. Effect of ICU quality control indicators on VAP incidence rate and mortality: a retrospective study of 1 267 hospitals in China［J］. Critical Care (London, England), 2022, 26(1): 405.［50］MUMTAZ H, EJAZ MK, TAY YAB M, et al. APACHE scoring as an indicator of mortality rate in ICU patients: a cohort study［J］. Ann Med Surg (Lond), 2023, 85(3): 416-421.［51］PATEL P, GUPTA S, PATEL H, et al. Assessment of APACHE II score to predict ICU outcomes of patients with AKI: a single-center experience from Haryana, North India［J］. Indian Journal of Critical Care Medicine, 2022, 26(3): 276-281.［52］JAWAD I,RASHAN S,SIGERAC, et al. A scoping review of registry captured indicators for evaluating quality of critical care in ICU［J］. J Intensive Care, 2021, 9(1): 48.［53］SHERMAN H, CASTRO G, FLETCHER M, et al. Towards an International Classification for Patient Safety: the conceptual framework［J］. International Journal for Quality in Health Care, 2009, 21(1): 2-8.

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更新日期/Last Update: 2024-05-15