Observational study of the relationship between volume and outcomes using data from the National Audit of Cardiac Rehabilitation
Observational study of the relationship between volume and outcomes using data from the National Audit of Cardiac Rehabilitation
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DOI：
10.1136/openhrt-2015-000304
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发表时间：
2015-10-01
期刊：
影响因子：
2.7
通讯作者：
Dale, Veronica
中科院分区：
文献类型：
--
作者：
Doherty, Patrick;Harrison, Alexander S.;Dale, Veronica
目标：心脏康复 (CR) 是由众多高容量和低容量中心提供的循证干预措施；然而，数量与结果关系的程度仍有待研究。关于容量对结果的影响缺乏共识，有证据表明急性和慢性护理中存在混合效应。本研究的目的是调查 CR 结果与患者数量之间的关联程度。方法：从每个 CR 中心 2012 年至 2013 年的国家审计中验证和提取数据。数量计算为进入门诊 CR 的患者总数。使用分层多元回归模型来测试数量和结果之间的关系。结果包括体重指数、血压、心理健康、胆固醇、戒烟和体力活动。根据中心和患者特征以及混杂因素对分析进行了调整。结果：纳入容量分析的患者人数为 48 476 名，来自 178 个 CR 中心。每个中心的平均年龄为 66 岁，入组患者中男性占 70%。回归分析显示，不存在容量与结果之间的关系，此外也不存在统计显着性。结论：与心脏手术不同，本研究在考虑了人员配置、年龄、性别和合并症后，显示容量对大容量和低容量计划实施的 CR 后的结果没有影响。根据我们的数据，不支持服务集中化。我们的研究结果和方法可以作为未来 CR 数量-结果关系研究的基准。
Objective: Cardiac rehabilitation (CR) is an evidence-based intervention delivered by a wide range of high-volume and low-volume centres; however, the extent of volume-outcome relationship is yet to be studied. There is a lack of consensus about the effect of volume on outcomes, with evidence of mixed effects in acute and chronic care. The aim of this study is, to investigate the extent of association of outcomes in CR with patient volume.Methods: Data was validated and extracted from the national audit from 2012 to 2013 for each CR centre. Volume was calculated as the total number of patients entering outpatient CR. Hierarchical multiple regression models were used to test for relationships between volume and outcomes. The outcomes included body mass index, blood pressure, psychosocial well-being, cholesterol, smoking cessation and physical activity. The analyses were adjusted for centre and patient characteristics and confounders.Results: The number of patients included in the volume analysis was 48 476, derived from 178 CR centres. The average age per centre was 66 years with a 70% male distribution of patients enrolled. Regression analysis revealed no volume-outcome relationship, additionally no statistical significance existed.Conclusions: Unlike cardiac surgery this study, after accounting for staffing, age, gender and comorbidity, shows no effect of volume on outcome following CR delivered by high-volume and low-volume programmes. Based on our data there is no support for centralisation of services. Our findings and methodology can be used as a benchmark for future volume-outcome relationship studies in CR.