Quality metrics and outcomes among critically ill patients in China:results of the national clinical quality control indicators for critical care medicine survey 2015-2019  

作　　者：Xi Rui Fen Dong Xudong Ma Longxiang Su Guangliang Shan Yanhong Guo Yun Long Dawei Liu Xiang Zhou 

机构地区：[1]Department of Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100029,China [2]Institute of Clinical Medical Sciences,China-Japan Friendship Hospital,Beijing 100029,China [3]Department of Medical Administration,National Health Commission of the People's Republic of China,Beijing 100044,China [4]Department of Epidemiology and Biostatistics,Institute of Basic Medicine Sciences,Chinese Academy of Medical Sciences(CAMS)&School of Basic Medicine,Peking Union Medical College,Beijing 100005,China

出　　处：《Chinese Medical Journal》2022年第9期1064-1075,共12页中华医学杂志（英文版）

基　　金：National Key R&D Program of China(No.2020YFC0861000);the CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2020-I2M-CoV19-001);the China International Medical Exchange Foundation Special Fund for Young and Middle-Aged Medical Research(No.Z-2018-35-1902);the 2020 CMB Open Competition Program(No.20-381);the Chinese Medical Information and Big Data Association(CHMIA)Special Fund for Emergency Project and Beijing Municipal Natural Science Foundation(M21019)。

摘　　要：Background:It is crucial to improve the quality of care provided to ICU patient,therefore a national survey of the medical quality of intensive care units(ICUs)was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in China from 2015 to 2019.Methods:This was an ICU-level study based on a 15-indicator online survey conducted in China.Considering that ICU care quality may vary between secondary and tertiary hospitals,direct standardization was adopted to compare the rates of ICU quality indicators among provinces/regions.Multivariate analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia(VAP),catheter-related bloodstream infections(CRBSIs),and catheter-associated urinary tract infections(CAUTIs).Results:From the survey,the proportions of structural indicators were 1.83%for the number of ICU inpatients relative to the total number of inpatients,1.44%for ICU bed occupancy relative to the total inpatient bed occupancy,and 51.08%for inpatients with Acute Physiology and Chronic Health Evaluation II scores≥15.The proportions of procedural indicators were 74.37%and 76.60%for 3-hour and 6-hour surviving sepsis campaign bundle compliance,respectively,62.93%for microbiology detection,58.24%for deep vein thrombosis prophylaxis,1.49%for unplanned endotracheal extubations,1.99%for extubated inpatients reintubated within 48 hours,6.38%for unplanned transfer to the ICU,and 1.20%for 48-hour ICU readmission.The proportions of outcome indicators were 1.28‰for VAP,3.06‰for CRBSI,3.65‰for CAUTI,and 10.19%for in-hospital mortality.Although the indicators varied greatly across provinces and regions,the treatment level of ICUs in China has been stable and improved based on various quality control indicators in the past 5 years.The overall mortality rate has dropped from 10.19%to approximately 8%.Conclusions:The quality indicators of medical care in China’s ICUs are heterogeneous,which is reflected in geograph

关 键 词：Medical quality ICU China Epidemiological survey 

分 类 号：R459.7[医药卫生—急诊医学]