提高价值围手术期提供者作用李弗莱舍leeafleisher.pdf

Improving perioperative value: the role of providers Lee A. Fleisher, M.D. Public Reporting of Hospital Mortality Nightingale F. Notes on Hospitals . 1863 3 What should we measure? 5 Surgery has gotten safer, but is it safe? Finks JF, et al. NEJM 2011 Complications and how they are treated influence Mortality Ghaferi AA et al. N Engl J Med 2009;361:1368-1375 Surgeons have been there: The National Surgical Quality Improvement Program (NSQIP) Khuri, S. F. et al. Arch Surg 2002;137:20-27. Measuring True es Observed/Expected Ratios Campbell et al. JACS 2008 e over time in National Surgical Quality Improvement Program Khuri, S. F. et al. Arch Surg 2002;137:20-27. Copyright restrictions may apply. What about anesthesia? Death Per 10,000 Anesthetics YEAR We are six sigma- is that true? Overall Health Care in U.S. (Rand) Breast cancer screening (65-69) Outpatient ABX for colds 1,000,000 Hospital acquired infections n o 100,000 Hospitalized patients i Post-MI injured through negligence l l i 10,000 -blockers m r