Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.
Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.
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DOI：
10.1001/jama.2009.1178
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发表时间：
2009-08-19
影响因子：
120.7
通讯作者：
Normand, Sharon-Lise T.
中科院分区：
文献类型：
--
作者：
Krumholz, Harlan M.;Wang, Yun;Chen, Jersey;Drye, Elizabeth E.;Spertus, John A.;Ross, Joseph S.;Curtis, Jeptha P.;Nallamothu, Brahmajee K.;Lichtman, Judith H.;Havranek, Edward P.;Masoudi, Frederick A.;Radford, Martha J.;Han, Lein F.;Rapp, Michael T.;Straube, Barry M.;Normand, Sharon-Lise T.
在过去的二十年中，医疗保健专业人员、消费者和付款人组织一直在寻求改善急性心肌梗死（AMI）住院患者的预后。然而，关于医院短期死亡率的改善或医院间短期死亡率差异的减少的报道很少。评估AMI出院患者住院30天风险标准化死亡率（RSMRs）。观察性研究，利用行政数据和一个经过验证的风险模型对1995年1月1日至2006年12月31日期间从美国非联邦急症医院出院的2 755 370名患者中的3 195 672例进行评估。患者年龄≥65岁（平均78岁），在住院前至少有12个月的服务收费登记史。非违反医嘱入院1天内活着出院的患者被排除在外，因为这些患者不太可能发生AMI。医院特定的30天全因RSMR在患者水平上，在高于全国平均水平1个标准差的医院接受治疗的患者与在低于全国平均水平1个标准差的医院接受治疗的患者在入院后30天内死亡的几率，1995年为1.63 (95% CI, 1.60-1.65)， 2006年为1.56 （95% CI, 1.53-1.60）。在医院特异性rsmr方面，观察到从1995年的18.8%下降到2006年的15.8%（优势比为0.76；95% CI为0.75-0.77）。rsmr的医院间异质性也有所降低：变异系数从1995年的11.2%下降到10.8%，四分位数间范围从2.8%下降到2.1%，医院间方差从4.4%下降到2.9%。1995年至2006年间，因急性心肌梗死而出院的医疗保险患者的风险标准化医院死亡率显著下降，医院之间的差异也是如此。
During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Observational study using administrative data and a validated risk model to evaluate 3 195 672 discharges in 2 755 370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Hospital-specific 30-day all-cause RSMR. At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation.
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影响因子：
120.7
作者：
Fox, Keith A. A.;Steg, Philippe Gabriel;Gore, Joel M.
通讯作者：
Gore, Joel M.
影响因子：
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作者：
Lewis, William R.;Peterson, Eric D.;Fonarow, Gregg C.
通讯作者：
Fonarow, Gregg C.
影响因子：
4.8
作者：
Kiyota, Y;Schneeweiss, S;Solomon, DH
通讯作者：
Solomon, DH
影响因子：
158.5
作者：
Rosamond, WD;Chambless, LE;Heiss, G
通讯作者：
Heiss, G
影响因子：
37.8
作者：
Myerson, Merle;Coady, Sean;Goff, David C., Jr.
通讯作者：
Goff, David C., Jr.