Access to revascularization among patients with acute myocardial infarction in New York City - Impact of hospital resources
Access to revascularization among patients with acute myocardial infarction in New York City - Impact of hospital resources
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DOI：
10.1007/s11524-006-9093-y
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发表时间：
2006-11-01
影响因子：
6.6
通讯作者：
Alderman, Michael H.
中科院分区：
文献类型：
--
作者：
Fang, Jing;Negassa, Abdissa;Alderman, Michael H.
及时行血运重建可提高急性心肌梗死患者的生存率。确定与适当患者血运重建术使用增加相关的因素可以改善预后。利用1988-1992年和1998-2002年的纽约市医院出院记录，我们确定了不同社区的心肌梗死住院患者的血运重建率。血运重建的优势比是使用一个空间模型来估计的，该模型调整了社区社会人口特征，同时考虑了地理上相邻社区之间血运重建率的相似性。纽约市112家医院中只有16家进行了冠状动脉血管重建术。它们位于41个社区中的14个。总的来说，住在有血运重建服务的医院的患者比例较高的社区的患者比住在有血运重建资源的医院的患者比例较低的社区的患者更有可能被血运重建。在考虑了社区的社会经济特征和患者的临床状况后，无论社区是否有血运重建，结果都是如此。从1988-1992年到1998-2002年，纽约市每个社区的血管重建率都有所增加，总体上每1 000名急性心肌梗塞住院患者的血管重建率从103人增加到326人。增加的原因并不是增加了新的血运重建服务。因此，在纽约市，只有某些医院可以进行血运重建术，有效地将患者送到拥有这些资源的医院似乎可以增加AMI患者血运重建术的可能性，而不会增加能够进行血运重建术的新医院的数量。
Timely revascularization can improve survival in patients with acute myocardial infarction. Identification of factors associated with increased use of revascularization in appropriate patients could improve outcomes. Using New York City hospital discharge records for 1988-1992 and 1998-2002, we determined revascularization rates for patients hospitalized with MI by neighborhood. Odds ratios for revascularization were estimated using a spatial model adjusting for neighborhood sociodemograpbic characteristics, while accounting for similarities in the rate of revascularization among geographically adjacent neighborhoods. Only 16 out of 112 New York City hospitals performed coronary revascularization. They were located in 14 of 41 neighborhoods. In general, patients living in neighborhoods with higher percentages of patients admitted to hospitals capable of revascularization service were more likely to be revascularized than those in neighborhoods with low percentages of patients admitted to hospitals with revascularization resources. This was true regardless of neighborhood availability of revascularization, after accounting for neighborhood socioeconomic characteristics and patients' clinical status. Revascularization rates in New York City increased from 1988-1992 to 1998-2002 in every neighborhood and as a whole from 103 to 326 per 1,000 hospitalized AMI patients. This increase was not explained by the addition of new revascularization services. Thus, in New York City, where only certain hospitals can perform revascularization, efficient delivery of patients to hospitals with these resources appears to increase the likelihood of revascularization performance among AMI patients without increasing the number of new hospitals capable of revascularization.