Narrowing performance gap between rural and urban hospitals for acute myocardial infarction care
Narrowing performance gap between rural and urban hospitals for acute myocardial infarction care
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DOI：
10.1016/j.ajem.2019.04.030
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发表时间：
2020-01-01
影响因子：
3.6
通讯作者：
Clements, John M.
中科院分区：
文献类型：
--
作者：
Alghanem, Fares;Clements, John M.
背景资料：农村社区在获得高质量医疗保健方面存在重大障碍，包括急性心肌梗死（AMI）后医疗保健的差异。本研究旨在确定是否县的人口密度，医疗保险患者住院后AMI预测短期结果，并量化纵向变化的医院性能的质量护理metrics.Methods：医院层面的数据查询从2012年和2018年医疗保险和医疗补助服务中心的档案。每个医院都是根据居住的县使用国家卫生统计中心城乡连续体代码（RUCC）进行分类。根据RUCC分类对风险调整结果和护理质量指标的变化和纵向变化进行分层并进行分析。结果：在确定的4798家医院中，农村医院的风险调整30天死亡率显著较高（r（s）= 0.095，p < 0.001），出院时他汀类药物处方减少（r（s）=-0.066，p = 0.004）。只有出院时处方的阿司匹林（R-2 = 0.003，p = 0.024）和他汀类药物（R-2 = 0.006，p = 0.001）与30天死亡率的改善相关。尽管存在这些差异，但从2012年到2018年，农村和城市医院之间的绩效差距在所有医疗质量指标上都有所缩小，死亡率和再入院率分别减少了1.83% [95%CI 1.76-1.90]和3.37% [95%CI 3.30-3.44]。在美国，只有适度的差异，目前存在农村和城市医院之间的医疗保健的急性心肌梗死。虽然绩效差距已经缩小，但有必要采取新的战略来改善及时有效的护理，以减轻农村社区残余的心血管保健差距。(C)2019爱思唯尔公司All rights reserved.
Background: Rural communities experience significant barriers to quality healthcare, including disparities in medical care following acute myocardial infarctions (AMI). This study sought to determine if the population density of the county where Medicare patients were hospitalized following AMI predicted short-term outcomes and to quantify longitudinal changes in hospital performance on quality of care metrics.Methods: Hospital-level data was queried from the 2012 and 2018 Centers for Medicare & Medicaid Services archives. Each hospital was classified based on residing county using the National Center for Health Statistics Rural-Urban Continuum Codes (RUCC). Variations and longitudinal changes in risk-adjusted outcomes and quality of care metrics were stratified by RUCC classification and analyzed.Results: Among the 4798 hospitals identified, rural hospitals had significantly higher risk-adjusted 30-day mortality (r(s) = 0.095, p < 0.001) and decreased statin prescribed at discharge (r(s) = -0.066, p = 0.004). Only aspirin (R-2 = 0.003, p = 0.024) and statin (R-2 = 0.006, p = 0.001) prescribed at discharge were correlated with improved 30-day mortality. Despite these differences, from 2012 to 2018 the performance gap between rural and urban hospitals narrowed for all but one quality of care metric, with concurrent 1.83% [95% CI 1.76-1.90] and 3.37% [95% CI 3.30-3.44] reductions in mortality and hospital readmissions, respectively.Conclusions: In the United States, only modest variations currently exist between rural and urban hospitals in the medical care of AMI. Although the performance gap has narrowed, new strategies to improve timely and effective care are necessary to alleviate residual cardiovascular healthcare disparities in rural communities. (C) 2019 Elsevier Inc. All rights reserved.