抗菌药物治疗前病原学送检率指标评价体系的构建与应用研究

Establishment and application for evaluation system of pathogen detection rate indicators before antimicrobial treatment

摘要:

目的 基于过程指标及结果指标构建住院患者抗菌药物治疗前病原学送检率的评价体系, 研究其应用效果。 方法 选取某三级甲等综合性医院2022年7月—2023年6月治疗性使用抗菌药物的住院患者为研究对象, 比较实施住院患者抗菌药物治疗前病原学送检率的评价体系干预前(2022年7—12月, 对照组)与干预后(2023年1—6月, 干预组)过程指标及结果指标的差异。 结果 治疗性使用抗菌药物的住院患者干预组为41 577例, 对照组为27 052例, 干预组病原学送检率及病原学送检正确率均较对照组提升(分别为74.2% VS 62.8%、90.3% VS 82.5%), 差异均有统计学意义(均P＜0.001)。病原学送检率目标达成率为237.5%, 进步率为18.2%。病原学送检正确率目标达成率为104.0%, 进步率为9.5%。过程指标中, 干预组病原学标本送检诊断符合率、病原学标本采集正确率、病原学标本转运及时率、病原学标本接收率均较对照组提升, 差异均有统计学意义(均P＜0.001)。结果指标中, 干预组指向性指标送检率、血培养标本送检率、限制级抗菌药物治疗前病原学送检率、特殊级抗菌药物治疗前病原学送检率、无菌体液标本送检率均较对照组提升, 差异有统计学意义(均P＜0.05)。此外, 血培养标本阳性率由干预前的18.5%提高至干预后的21.7%, 差异有统计学意义(P＜0.05)。 结论 构建指标评价体系, 可以提升抗菌药物治疗前病原学送检率及送检正确率, 改善指标的管理质量与内涵。

Abstract:

Objective To establish an evaluation system of pathogen detection rate of hospitalized patients before antimicrobial treatment based on process and outcome indicators, and study its application effect. Methods Hospitalized patients with therapeutic antimicrobial treatment in a tertiary first-class hospital from July 2022 to June 2023 were selected as the study objects. Difference in process and outcome indicators were compared between before (July-December 2022, control group) and after (January-June 2023, intervention group) the implementation of intervention in the evaluation system for pathogen detection rate of hospitalized patients before antimicrobial treatment. Results 41 577 and 27 052 hospitalized patients received therapeutic antimicrobial agents were included in the intervention group and control group, respectively. Pathogen detection rate and the accurate pathogen detection rate in the intervention group were both higher than those in the control group (74.2% vs 62.8% and 90.3% vs 82.5%, respectively), both with statistically significant differences (both P < 0.001). The goal achievement rate and improvement rate for pathogen detection rate were 237.5% and 18.2% respectively, the goal achievement rate and improvement rate for accurate pathogen detection rate were 104.0% and 9.5% respectively. For the process indicators, the conformity rate of detection and diagnosis, accurate collection rate, timely transfer rate, acceptance rate of pathogen specimens in the intervention group were all higher than those in the control group, differences were all statistically significant (all P < 0.001). For the outcome indicators, detection rates of targeted indicators and blood culture specimens, pathogen detection rate before treatment of restricted and special grade antimicrobial agent, as well as detection rate of sterile body fluid specimens in the intervention group were all higher than those in the control group, with statistical significance (all P < 0.05). In addition, the positive rate of blood culture specimens increased from 18.5% before intervention to 21.7% after intervention, with statistically significant difference (P < 0.05). Conclusion The establishment of indicator evaluation system can improve the detection rate and accurate detection rate of pathogens before antimicrobial treatment, as well as the management quality and connotation of indicators.