Quality of care for acute myocardial infarction in rural and urban US hospitals
Quality of care for acute myocardial infarction in rural and urban US hospitals
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DOI：
10.1111/j.1748-0361.2004.tb00015.x
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发表时间：
2004-03-01
影响因子：
4.9
通讯作者：
Chan, L
中科院分区：
文献类型：
--
作者：
Baldwin, LM;MacLehose, RF;Chan, L
背景：急性心肌梗死(AMI)是美国乡村医院常见而重要的入院原因，因为将急性心肌梗死患者运送到城市环境可能会导致不可接受的护理延误。目的：了解远离城市中心不同程度的乡村医院对急性心肌梗死患者的护理质量。方法：这项队列研究使用了合作心血管项目(CCP)的数据，包括4,085家急性护理医院(408家偏远的小型农村医院、893家小型农村医院、619家大型农村医院和2,165家城市医院)，在1994年2月至1995年7月期间，有135,759名65岁及以上的老年医疗保险受益人直接入院治疗确诊的急性心肌梗死。结果包括住院期间使用阿司匹林、再灌注、肝素和静脉注射硝酸甘油；出院时使用β-受体阻滞剂、阿司匹林和血管紧张素转换酶(ACE)抑制剂；出院时避免使用钙通道阻滞剂，以及30天死亡率。研究结果：在城市和乡村医院中，相当大比例的医疗保险受益人没有接受推荐的急性心肌梗死治疗。与城市医院的患者相比，乡村医院的医疗保险患者接受阿司匹林、静脉注射硝酸甘油、肝素以及溶栓剂或经皮冠状动脉腔内成形术的可能性较小。只有出院时使用血管紧张素转换酶抑制剂的农村医院的患者比城市医院的患者使用得更多。农村医院的医疗保险患者在急性心肌梗死后30天的调整后各种原因死亡率高于城市医院(农村大医院的优势比为1.14[1.10比1.18]，农村小医院的优势比为1.24[1.20比1.29]，偏远小农村的优势比为1.32[1.23比1.41])。结论：需要努力帮助城乡地区的医院医务人员建立系统，以确保患者接受推荐的急性心肌梗死治疗。
Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge, and 30-day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.