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A review of hospital characteristics associated with improved performance

机译：回顾与改善绩效相关的医院特征

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Purpose. The objective of this review was to critically appraise the literature relating to associations between high-level struc-tural and operational hospital characteristics and improved performance. Data sources. The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. Study selection and data extraction. Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis. Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. Conclusion. There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are indicated.
机译：目的。这篇综述的目的是对有关高层结构性医院和运营医院特征与绩效改善之间关联的文献进行严格评估。数据源。检索了Cochrane图书馆，MEDLINE（Ovid），CINAHL，proQuest和PsychINFO之间在1996年1月至2010年5月之间发表的文章。对其中包括的文章的参考文献清单进行了审查，并手工搜索了重要期刊中的相关文章。研究选择和数据提取。如果研究是系统评估或荟萃分析，随机对照试验，在研究前后的观察或对照研究（队列和横断面研究），这些研究是多中心的，比较性能研究，则将其包括在内。两位审稿人独立提取数据，根据澳大利亚国家卫生与医学研究委员会的指导原则分配证据等级，并对其中的文章进行严格评估。数据综合。在12篇系统评价和47篇观察性文章中报告了57项研究。在使用和绩效结果的定义上存在异质性。调查的医院特征包括环境（激励措施，市场特征），结构（网络成员，所有权，教学状况，地理环境，服务规模）和运营设计（创新性，领导力，组织文化，公共报告和患者安全实践，信息技术系统和决策支持，服务活动和计划，员工队伍设计，员工培训和教育）。对于计算机医师订单输入系统，确定了与总体绩效相关的最有力证据。一些证据支持了以下方面的关联：劳动力设计，财务激励措施的使用，护理领导和医院数量。结论。证据有限，主要是低质量的证据，支持医院特征与医疗保健绩效之间的关联。指出了进一步的特定于特性的系统评价。

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