Variation Across Hospitals in In-Hospital Cardiac Arrest Incidence Among Medicare Beneficiaries.
Variation Across Hospitals in In-Hospital Cardiac Arrest Incidence Among Medicare Beneficiaries.
复制标题
DOI：
10.1001/jamanetworkopen.2021.48485
复制
发表时间：
2022-02-01
影响因子：
13.8
通讯作者：
Girotra S
中科院分区：
文献类型：
--
作者：
Rasmussen TP;Riley DJ;Sarazin MV;Chan PS;Girotra S
老年患者院内心脏骤停（IHCA）的发生率是多少？不同医院的发生率是否不同？在一项使用与医疗保险相关的指南复苏数据的观察性队列研究中，IHCA的总发病率为每1000例入院患者8.53例，即使在调整了病例组合严重程度的差异后，各医院的发病率也有很大差异（范围，2.4-25.5）。较高的护士配备和教学水平与较低的医院IHCA发生率相关。这些发现表明，即使在调整了患者病例组合之后，美国各医院的IHCA发病率也存在显著差异。本队列研究考察了医疗保险受益人在医院内心脏骤停发生率的差异。虽然住院心脏骤停（IHCA）的生存率在过去20年里有了显著提高，但近年来生存率趋于稳定。更好地了解IHCA发病率的医院差异可能为预防IHCA的最佳实践提供重要见解。确定医疗保险受益人中IHCA的发生率，并评估IHCA发生率在医院的差异。这项观察性队列研究分析了2014年至2017年来自170家医院的数据，这些医院参与了与医疗保险档案相关的指南复苏登记处。参与者为65岁及以上的成年人。统计分析时间为2021年1月至12月。病例组合指数、教学状况和护士配备情况。医疗保险受益人中IHCA的住院发病率估计为IHCA患者人数除以住院总人数。采用多变量层次回归模型计算经患者病例组合差异调整后的医院发病率，并评估医院变量与IHCA发病率的关系。在170家医院的450万人次就诊中，2014年至2017年期间有38630名患者经历了IHCA。38630例IHCAs患者中，非西班牙裔黑人7571例（19.6%），非西班牙裔白人26715例（69.2%），女性16732例（43.3%）；入院时平均（SD）年龄为76.3（7.8）岁。经风险调整后的IHCA发病率中位数为8.5 / 1000例（95% CI, 8.2-9.0 / 1000例）。在调整了病例组合指数的差异后，不同医院的IHCA发病率差异显著，从2.4 / 1000到25.5 / 1000不等（IQR, 6.6-11.4；中位优势比为1.51 [95% CI, 1.44-1.58]）。在医院变量中，较高的病例组合指数、较高的护士配备和教学状况与较低的医院IHCA发病率相关。本队列研究发现，不同医院的IHCA发病率差异显著，护士配备和教学水平较高的医院IHCA发病率较低。未来的研究需要更好地了解在IHCA发生率极低的医院的护理过程，以确定预防心脏骤停的最佳做法。
What is the incidence of in-hospital cardiac arrest (IHCA) among older patients and does the incidence vary across hospitals? In an observational cohort study using Get With the Guidelines-Resuscitation data linked with Medicare, the overall IHCA incidence was 8.53 per 1000 admissions with large variation in incidence across hospitals (range, 2.4-25.5), even after adjusting for differences in case-mix severity. Higher nurse staffing and teaching status was associated with a lower hospital incidence of IHCA. These findings suggest that incidence of IHCA varies markedly across US hospitals, even after adjusting for patient case-mix. This cohort study examines the variation across hospitals in incidence of in-hospital cardiac arrest among Medicare beneficiaries. Although survival for in-hospital cardiac arrest (IHCA) has improved substantially over the last 2 decades, survival rates have plateaued in recent years. A better understanding of hospital differences in IHCA incidence may provide important insights regarding best practices for prevention of IHCA. To determine the incidence of IHCA among Medicare beneficiaries, and evaluate hospital variation in incidence of IHCA. This observational cohort study analyzes 2014 to 2017 data from 170 hospitals participating in the Get With The Guidelines-Resuscitation registry, linked to Medicare files. Participants were adults aged 65 years and older. Statistical analysis was performed from January to December 2021. Case-mix index, teaching status, and nurse-staffing. Hospital incidence of IHCA among Medicare beneficiaries was estimated as the number of IHCA patients divided by the total number of hospital admissions. Multivariable hierarchical regression models were used to calculate hospital incidence rates adjusted for differences in patient case-mix and evaluate the association of hospital variables with IHCA incidence. Among a total of 4.5 million admissions at 170 hospitals, 38 630 patients experienced an IHCA during 2014 to 2017. Among the 38 630 patients with IHCAs, 7571 (19.6%) were non-Hispanic Black, 26 715 (69.2%) were non-Hispanic White, and 16 732 (43.3%) were female; the mean (SD) age at admission was 76.3 (7.8) years. The median risk-adjusted IHCA incidence was 8.5 per 1000 admissions (95% CI, 8.2-9.0 per 1000 admissions). After adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals ranging from 2.4 per 1000 admissions to 25.5 per 1000 admissions (IQR, 6.6-11.4; median odds ratio, 1.51 [95% CI, 1.44-1.58]). Among hospital variables, a higher case-mix index, higher nurse staffing, and teaching status were associated with a lower hospital incidence of IHCA. This cohort study found that the incidence of IHCA varies markedly across hospitals, and hospitals with higher nurse staffing and teaching status had lower IHCA incidence rates. Future studies are needed to better understand processes of care at hospitals with exceptionally low IHCA incidence to identify best practices for cardiac arrest prevention.
登录
查看更多内容
影响因子：
24
作者：
Ofoma UR;Basnet S;Berger A;Kirchner HL;Girotra S;American Heart Association Get With the Guidelines – Resuscitation Investigators
通讯作者：
American Heart Association Get With the Guidelines – Resuscitation Investigators
影响因子：
9.6
作者：
Churpek, Matthew M.;Yuen, Trevor C.;Edelson, Dana P.
通讯作者：
Edelson, Dana P.
DOI：
10.1161/circoutcomes.120.006837
发表时间：
2020-07-01
影响因子：
6.9
作者：
Girotra, Saket;Tang, Yuanyuan;Nallamothu, Brahmajee K.
通讯作者：
Nallamothu, Brahmajee K.
影响因子：
4.8
作者：
Chan, Maya L.;Spertus, John A.;Chan, Paul S.
通讯作者：
Chan, Paul S.
影响因子：
6.5
作者：
Andersen, Lars W.;Kim, Won Young;Donnino, Michael W.
通讯作者：
Donnino, Michael W.