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根据医院绩效分析的心肌梗死后的预期寿命
Life Expectancy after Myocardial Infarction, According to Hospital Performance


Emily M. Bucholz ... 心脑血管疾病 • 2016.10.06

摘要


背景

急性心肌梗死后30天的风险标准化死亡率常被用来评估和比较医院的绩效。但尚不清楚不同医院间急性心肌梗死患者早期生存率的差异是否与长期生存率的差异相关。

 

方法

我们分析了来自心血管合作计划(Cooperative Cardiovascular Project)的数据,研究对象为1994—1996年因急性心肌梗死住院并接受了17年随访的美国老年医疗保险(Medicare)受益人。我们根据病例组合的严重程度,将医院分为5个层次。在每个病例组合层次中,我们对高绩效医院收治患者和低绩效医院收治患者的预期寿命进行了比较。医院绩效根据30天风险标准化死亡率的五分位数来界定。Cox比例风险模型被用来计算预期寿命。

 

结果

研究样本包括了1,824家医院收治的119,735例急性心肌梗死患者。在各病例组合层次中,最初30天内,由于医院收治的患者分属不同的风险标准化死亡率的五分位数区间,其生存曲线彼此分离,并在之后17年的随访中保持平行。随着风险标准化死亡率五分位数的增高,估算的预期寿命缩短。按照医院的病例组合进行比较,在高效能医院接受治疗的患者,其寿命比在低效能医院就诊的患者平均延长0.74~1.14年。当单独调查30天生存的患者时,在医院风险标准化死亡率五分位数之间,未经校正或校正后的预期寿命均无显著差异。

 

结论

在这项研究中,急性心肌梗死后被高绩效医院收治的患者与在低绩效医院接受治疗的患者相比,预期寿命更长。这一生存获益发生在最初的30天内,并长期持续存在(由美国国家心肺血液研究所[National Heart, Lung, and Blood Institute]以及美国国立综合医学研究所的医学科学家培训计划[National Institute of General Medical Sciences Medical Scientist Training Program]共同资助)。





作者信息

Emily M. Bucholz, M.D., Ph.D., M.P.H., Neel M. Butala, M.D., Shuangge Ma, Ph.D., Sharon-Lise T. Normand, Ph.D., and Harlan M. Krumholz, M.D.
From the Department of Medicine, Boston Children’s Hospital (E.M.B.), the Department of Internal Medicine, Massachusetts General Hospital (N.M.B.), the Department of Health Care Policy, Harvard Medical School (S.-L.T.N.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (S.-L.T.N.) — all in Boston; and the Departments of Biostatistics (S.M.) and Health Policy and Management (H.M.K.), Yale School of Public Health, the Section of Cardiovascular Medicine, Department of Internal Medicine, and Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine (H.M.K.), and Center for Outcomes Research and Evaluation, Yale–New Haven Hospital (H.M.K.) — all in New Haven, CT. Address reprint requests to Dr. Krumholz at the Department of Internal Medicine, Yale School of Medicine, 1 Church St., Suite 200, New Haven, CT 06510, or at harlan.krumholz@yale.edu.

 

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