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目的：探索跨专业协作的置信职业行为医师评价制度对择期手术质量的影响。方法：采用德尔菲法构建跨专业协作的EPA评价体系，据此实施外科医师手术能力评估及权限准入管理。通过病案系统提取新制度实施前后各1年的择期手术患者数据，对照组(7572例)与实验组(7561例)经倾向性得分匹配后保留14 160例(各7080对)。配对数据采用多因素Logistic回归分析评价方式与手术并发症的关联性，并行中介效应检验。结果：匹配后实验组手术并发症发生率显著低于对照组(0.78%比0.44%，χ2=6.74,P=0.009)。调整年龄、手术分级和专科手术后，EPA评价方式与并发症风险降低显著相关(χ2=2.01,P=0.045,OR=1.79,95%CI:1.01～3.15)。评价方式与降低手术并发症发生存在有统计意义的直接效应。结论：基于置信职业行为的外科医师评价可降低手术并发症发生率，有利于提升医疗质量安全。
Abstract：Objective:To investigate the impact of an Entrustable Professional Activities(EPA)-based interprofessional collaborative evaluation on elective surgical quality.Methods:A Delphi method was employed to establish a interprofessional EPA evaluation framework for assessing surgical competence and credentialing management. Patient data from one year before and after EPA evaluation implementation were extracted from medical records,with 7572 cases in the control group and 7561 cases in the experimental group. After propensity score matching,14 160 cases(7080 pairs each)were retained.Results:the experimental group exhibited significantly lower complication rate than the control group(0.78% vs 0.44%,χ2=6.74,P=0.009). After adjusting for age,surgical complexity,and specialty,the EPA-based evaluation was found associated with reduced complication risk(χ2=2.01,P=0.045,OR=1.79,95%CI:1.01-3.15). A statistically significant direct effect was observed between the evaluation system and complication reduction(χ2=0.23,P=0.011,OR=-0.57,95%CI:-1.01 to-0.13).Conclusions:EPAbased surgical assessment reduces postoperative complications and enhances healthcare quality and safety.
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基本信息:
中图分类号:R197.323
引用信息:
[1]梁玉莹,叶祉青,袁西,等.基于置信职业理论的外科医师评价制度对择期手术质量的实证研究[J].广州医科大学学报,2025,53(04):22-28.
基金信息:
广东省教育厅临床教学基地教学改革研究项目（2021JD116）
2025-08-15
2025-08-15