CLBSI用手算和用電腦算差很多
意思就是說，健保局想用pay-for-performance，用健保大電腦來看你的performance來給你錢，是不通的
前一陣子寫過一個台大公衛所的問卷，列出很多種infection, 包括VAP, HAP, SSI, CLBSI, UTI等指標，問說，你覺得哪種最能代表一個醫院的照護品質，因為採delphi methods，可看到大家的第一意見都是選CLBSI(還用說),也許哪一天一個報告出來，說「專家們」都認為CLBSI最能代表品質，那我們就開始論質計酬吧! ==> 到時候可以拿這個報告出來給蛋頭學者看一下…記得是賴美淑老師指導的學生
做這個infection survey 是做內部管理用的，有時和同儕比較一下，不是給你秤斤秤兩算錢用的。老子成天收爛病人，是盡社會義務，不是用來給你嫌東嫌西扣錢用的。
Surveillance for Central Line–Associated Bloodstream Infections
The correlation between infection preventionist– and algorithm-determined infection rates was weak and varied markedly among the hospitals studied.
With pay-for-performance metrics now focusing on healthcare-acquired infections, the accuracy with which such infections are identified will have substantial financial implications for hospitals. Moreover, for interhospital comparisons to be valid, surveillance methods must be uniform and reliable across institutions. The recent development of computer algorithms for central line–associated bloodstream infection (CLABSI) surveillance allows the establishment of a reference standard to assess the accuracy and reliability of current surveillance systems.
In an analysis involving 20 intensive care units across four academic medical centers, investigators compared CLABSI incidence rates as determined by traditional infection-preventionist surveillance for 2004 to 2007 with those determined by a computer algorithm. The computer algorithm approximated the CDC CLABSI surveillance definition used by the infection preventionists during the study period.
The median rate of CLABSI as determined by the infection preventionists was significantly lower than that determined by the computer algorithm (3.3 vs. 9.0 per 1000 central line–days). The overall correlation between preventionist- and algorithm-determined infection rates was weak and varied markedly among the hospitals. Most important, the relative ranking of hospital CLABSI rates differed significantly depending on the surveillance systems used: The hospital with the highest CLABSI rate as determined by the computer algorithm had the lowest rate as determined by infection preventionists.
Comment: The computer algorithm employed in this analysis cannot be considered a gold standard. Still, its use as an objective benchmark highlights limitations in the application of the CDC CLABSI surveillance definition that must be addressed if the planned pay-for-performance metrics are to be applied fairly.
— Richard T. Ellison III, MD
Published in Journal Watch Infectious Diseases November 17, 2010
Citation(s):
Lin MY et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010 Nov 10; 304:2035.
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7YzU1MmExZTMtMjAxZi00M2UwLTg3ODYtNTYxYTM0YWMwZDg3&hl=zh_TW
前一陣子寫過一個台大公衛所的問卷，列出很多種infection, 包括VAP, HAP, SSI, CLBSI, UTI等指標，問說，你覺得哪種最能代表一個醫院的照護品質，因為採delphi methods，可看到大家的第一意見都是選CLBSI(還用說),也許哪一天一個報告出來，說「專家們」都認為CLBSI最能代表品質，那我們就開始論質計酬吧! ==> 到時候可以拿這個報告出來給蛋頭學者看一下…記得是賴美淑老師指導的學生
做這個infection survey 是做內部管理用的，有時和同儕比較一下，不是給你秤斤秤兩算錢用的。老子成天收爛病人，是盡社會義務，不是用來給你嫌東嫌西扣錢用的。
Surveillance for Central Line–Associated Bloodstream Infections
The correlation between infection preventionist– and algorithm-determined infection rates was weak and varied markedly among the hospitals studied.
With pay-for-performance metrics now focusing on healthcare-acquired infections, the accuracy with which such infections are identified will have substantial financial implications for hospitals. Moreover, for interhospital comparisons to be valid, surveillance methods must be uniform and reliable across institutions. The recent development of computer algorithms for central line–associated bloodstream infection (CLABSI) surveillance allows the establishment of a reference standard to assess the accuracy and reliability of current surveillance systems.
In an analysis involving 20 intensive care units across four academic medical centers, investigators compared CLABSI incidence rates as determined by traditional infection-preventionist surveillance for 2004 to 2007 with those determined by a computer algorithm. The computer algorithm approximated the CDC CLABSI surveillance definition used by the infection preventionists during the study period.
The median rate of CLABSI as determined by the infection preventionists was significantly lower than that determined by the computer algorithm (3.3 vs. 9.0 per 1000 central line–days). The overall correlation between preventionist- and algorithm-determined infection rates was weak and varied markedly among the hospitals. Most important, the relative ranking of hospital CLABSI rates differed significantly depending on the surveillance systems used: The hospital with the highest CLABSI rate as determined by the computer algorithm had the lowest rate as determined by infection preventionists.
Comment: The computer algorithm employed in this analysis cannot be considered a gold standard. Still, its use as an objective benchmark highlights limitations in the application of the CDC CLABSI surveillance definition that must be addressed if the planned pay-for-performance metrics are to be applied fairly.
— Richard T. Ellison III, MD
Published in Journal Watch Infectious Diseases November 17, 2010
Citation(s):
Lin MY et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010 Nov 10; 304:2035.
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7YzU1MmExZTMtMjAxZi00M2UwLTg3ODYtNTYxYTM0YWMwZDg3&hl=zh_TW
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