Association of Hospital and Provider Types on Sickle Cell Disease Outcomes
Association of Hospital and Provider Types on Sickle Cell Disease Outcomes
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医院和医疗机构类型对镰状细胞病治疗结果的影响
DOI：
10.1542/peds.2013-0089
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发表时间：
2013-11-01
期刊：
影响因子：
8
通讯作者：
Rubin, David M.
中科院分区：
文献类型：
--
作者：
Jan, Sophia;Slap, Gail;Rubin, David M.
诊断：患有镰状细胞病（SCD）的青少年和年轻人（A/YA）在儿童医院和综合医院住院。我们确定了医院类型和提供者专业对住院A/YA伴SCD和急性胸部综合征（ACS）患者结局的影响。这项回顾性队列研究使用了2007-2009年的Premier数据库，这是一个大型的多机构数据库，从2007年到2009年，从256家美国医院中确定了1476名16至25岁的SCD和ACS患者，其中2299名患者出院。在调整患者人口统计学、临床和医院特征后进行多水平logistic回归和零截尾负二项回归，以检验医院类型和提供者专业对死亡、气管插管、简单或交换输血、住院时间（LOS）和30天再入院的相关性。综合医院有13例死亡，与较高的插管率有关（预测概率[PP]，48% [95%置信区间（CI），43%-52%]）和更长的LOS（预测平均LOS，7.6天[95% CI，7.2-7.9]）与儿童医院相比（插管PP，24% [95% CI，5%-42%];预测平均LOS，6.8天[95% CI，5.6-5.8]）。有没有不同的医院类型或供应商专业PP的简单或交换输血，或30天reincipsion.Conclusions：综合医院进行较高的插管风险A/YA与SCD和ACS相比，儿童医院。我们需要更好地了解这些差异的驱动因素，包括工作人员专业知识的作用，医院数量和持续SCD护理的质量。
OBJECTIVES: Adolescents and young adults (A/YA) with sickle cell disease (SCD) are hospitalized in both children's and general hospitals. We determined the effect of hospital type and provider specialty on outcomes of hospitalized A/YA with SCD and acute chest syndrome (ACS).METHODS: This retrospective cohort study used the 2007-2009 Premier Database, a large multi-institutional database, to identify 1476 patients ages 16 to 25 years with 2299 admissions with SCD and ACS discharged from 256 US hospitals from 2007 to 2009. Multilevel logistic regression and zero-truncated negative binomial regression were performed after adjustment for patient demographic, clinical, and hospital characteristics to test the association of hospital type and provider specialty on death, endotracheal intubation, simple or exchange transfusion, length of stay (LOS), and 30-day readmission.RESULTS: Of all admissions, 14 died and 45% were intubated. General hospitals had 13 deaths and were associated with higher intubation rates (predicted probability [PP], 48% [95% confidence interval (CI), 43%-52%]) and longer LOS (predicted mean LOS, 7.6 days [95% CI, 7.2-7.9]) compared with children's hospitals (PP of intubation, 24% [95% CI, 5%-42%]; and predicted mean LOS, 6.8 days [95% CI, 5.6-5.8]). There was no difference by hospital type or provider specialty in PP of simple or exchange transfusion, or 30-day readmission.CONCLUSIONS: General hospitals carry higher intubation risks for A/YA with SCD and ACS compared with children's hospitals. We need to better understand the drivers of these differences, including the role of staff expertise, hospital volume, and quality of ongoing SCD care.