Differences among geriatricians, general internists, and cardiologists in the care of patients with heart failure: a cautionary tale of quality assessment.
Differences among geriatricians, general internists, and cardiologists in the care of patients with heart failure: a cautionary tale of quality assessment.
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老年科医生、普通内科医生和心脏病专家在心力衰竭患者护理方面的差异：质量评估的警示故事。
DOI：
10.1111/j.1532-5415.1998.tb06000.x
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发表时间：
1998
影响因子：
6.3
通讯作者：
Lang,RM
中科院分区：
文献类型：
--
作者：
Chin,MH;Wang,JC;Zhang,JX;Sachs,GA;Lang,RM
目的：描述由老年科医生、普通内科医生、心脏病专家和组合医生治疗的心力衰竭患者的特征、护理过程和资源利用方面的差异。设计：一项回顾性队列研究。地点：城市学术医疗中心。参与者：总共 439 名门诊患者，被诊断为心力衰竭或心肌病，并由老年科医生、普通内科医生、心脏病专家和组合治疗。测量：测量人口统计学和临床特征、药物使用、诊断测试、住院治疗以及住院和门诊费用。结果：与心脏病专家的患者相比，老年科医生护理的患者年龄更大，更有可能患有高血压、舒张功能障碍和高合并症，并且不太可能接受超声心动图、心导管插入术和心电图检查。收缩功能降低的患者中血管紧张素转换酶抑制剂的使用情况相似。由老年科医生护理的患者与心脏病专家的患者具有相同的费用、住院率和出现症状的可能性。结论：仅由老年科医生看诊的心力衰竭患者的护理过程与其他医生看诊的患者的护理过程不同，但病例组合也有所不同。老年病学家对左心室功能的评估可能需要加强。然而，尽管老年科医生的患者年龄较大且合并症较多，但其总费用和症状与心脏病专家的患者相似。未来的工作需要确定哪些患者最有可能从老年科医生的治疗中受益，并确定如何在不同类型的医生和卫生服务提供者之间最佳地协调护理。
OBJECTIVES:To describe differences in the characteristics, processes of care, and resource utilization of patients with heart failure cared for by geriatricians, general internists, cardiologists, and combinations of physicians.DESIGN:A retrospective cohort study.SETTING:An urban academic medical center.PARTICIPANTS:A total of 439 outpatients with a billing diagnosis of heart failure or cardiomyopathy who were treated by geriatricians, general internists, cardiologists, and combinations of physicians.MEASUREMENTS:Demographic and clinical characteristics, medication use, diagnostic testing, hospitalizations, and inpatient and outpatient costs were measured.RESULTS:Compared with patients of cardiologists, patients cared for by geriatricians were older, more likely to have hypertension, diastolic dysfunction, and high comorbidity, and less likely to undergo echocardiography, cardiac catheterization, and electrocardiography. Use of angiotensin‐converting enzyme inhibitors was similar among patients with reduced systolic function. Patients cared for by geriatricians had the same costs, rates of hospitalization, and likelihood of being symptomatic as patients of cardiologists.CONCLUSIONS:The processes of care for patients with heart failure seen solely by geriatricians differ from those for patients seen by other physicians, but the case‐mix also varies. Assessment of left ventricular function by geriatricians probably needs to be increased. However, although they were older and had more comorbidity, patients of geriatricians had total costs and symptomatology similar to those of patients of cardiologists. Future work is needed to identify those patients most likely to benefit from treatment by geriatricians and to determine how care can be optimally coordinated among different types of physicians and health providers.