Outcome of myocardial infarction in Veterans Health Administration patients as compared with medicare patients.
Outcome of myocardial infarction in Veterans Health Administration patients as compared with medicare patients.
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DOI：
10.1056/nejm200012283432606
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发表时间：
2000-12-28
影响因子：
158.5
通讯作者：
McNeil, BJ
中科院分区：
文献类型：
--
作者：
Petersen, LA;Normand, ST;McNeil, BJ
背景资料：有些人认为，在退伍军人健康管理局（VHA）医院接受护理的病人比在非VHA机构接受护理的病人质量差。为了评估VHA医院的护理质量，我们比较了VHA和非VHA医院的急性心肌梗死患者的结局，同时控制了潜在的混杂因素，包括共存条件和疾病的严重程度。方法：我们研究了从81家VHA医院出院的2486名退伍军人和从1530家非VHA医院出院的29,249名医疗保险患者，将我们的样本限制在至少65岁的男性中，这些男性出院时被证实患有急性心肌梗死。我们比较了两个样本的共存条件、疾病严重程度以及30天和1年死亡率。VHA患者比Medicare患者更有可能有记录的高血压史（64.3%对57.3%），慢性阻塞性肺病或哮喘（30.9%对23.5%），糖尿病（34.8%对29.0%），中风（20.4%对14.2%）或痴呆（7.2%对4.8%）（P
Background: Some have the opinion that patients cared for in Veterans Health Administration (VHA) hospitals receive care of poorer quality than those cared for in non-VHA institutions. To assess the quality of care in VHA hospitals, we compared the outcome of acute myocardial infarction among patients in VHA and non-VHA institutions while controlling for potential confounders, including coexisting conditions and severity of illness.Methods: We studied 2486 veterans discharged from 81 VHA hospitals and 29,249 Medicare patients discharged from 1530 non-VHA hospitals, restricting our samples to men at least 65 years of age who were discharged with confirmed acute myocardial infarction. We compared coexisting conditions, severity of illness, and 30-day and 1-year mortality in the two samples.Results: VHA patients were significantly more likely than Medicare patients to have a recorded history of hypertension (64.3 percent vs. 57.3 percent), chronic obstructive pulmonary disease or asthma (30.9 percent vs. 23.5 percent), diabetes (34.8 percent vs. 29.0 percent), stroke (20.4 percent vs. 14.2 percent), or dementia (7.2 percent vs. 4.8 percent) (P