Variation in care and outcome following myocardial infarction
Variation in care and outcome following myocardial infarction
复制标题
心肌梗死后护理和结果的变化
DOI：
10.1136/bmj.h4133
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Dharmarajan K
中科院分区：
文献类型：
--
作者：
Dharmarajan K
描述医院治疗和结局变化的研究改善了急性心肌梗死患者的护理。研究，特别是来自美国的研究，显示医院使用基于证据的检测和治疗急性心肌梗死（包括阿司匹林、β受体阻滞剂和血管紧张素转换酶抑制剂）存在显著差异。[1]作为回应，美国主要组织制定了一套被视为标准治疗的核心流程措施。2医院在这些措施上的表现被公开报道，并用于指导报销。3随后，研究发现医院对急性心肌梗死的结果存在显著差异，包括30天再入院率和死亡率。4.联邦政府利用医院在这些指标上的表现，对30天结果比预期差的机构进行经济处罚。5正是由于这种对医疗质量的关注，Chung及其同事在相关论文中（doi：10.1136/bmj. h3913）描述了英国和瑞典急性心肌梗死患者的指南推荐治疗和结局的变化。6作者检查了2004年至2010年两国所有提供急性心肌梗死护理的医院的全国注册数据。他们发现，许多指南推荐的治疗方法（如ST段抬高心肌梗死的直接经皮介入治疗和所有梗死亚型的β受体阻滞剂治疗）的使用差异在英国高于瑞典。他们还发现，在病例组合标准化后，英国医院30天死亡率的变异性更大。在这两个国家，约四分之一的医院30天死亡率的变化是由基于指南的护理的使用变化解释的。在不太可能提供指南一致护理的医院，死亡风险较高。
Research describing variation in hospital treatment and outcomes has improved care for patients with acute myocardial infarction. Studies, particularly from the United States, have shown significant differences in hospitals’ use of evidence based tests and treatments for acute myocardial infarction including aspirin, β blockers, and angiotensin converting enzyme inhibitors. 1 In response, major US organizations developed a set of core process measures for treatments considered to be standard of care. 2 Hospitals’ performance on these measures were publicly reported and used to guide reimbursement. 3 Subsequently, research identified significant variation in hospitals’ outcomes for acute myocardial infarction, including rates of 30 day readmission and mortality. 4 The federal government has used hospitals’ performance on these metrics to exact financial penalties on institutions with worse than expected 30 day outcomes. 5It is with this focus on quality of healthcare that Chung and colleagues in the linked paper (doi: 10.1136/bmj. h3913) describe variation in guideline recommended treatments and outcomes for patients admitted with acute myocardial infarction in the United Kingdom and Sweden. 6 The authors examined nationwide registry data from all hospitals providing care for acute myocardial infarction in both countries between 2004 and 2010. They found that variation in use of many guideline recommended treatments such as primary percutaneous intervention for ST elevation myocardial infarction and β blocker treatment for all infarction subtypes was higher in the United Kingdom than Sweden. They also found that variability in 30 day mortality was greater in UK hospitals after standardization for case mix. Approximately a quarter of variation in 30 day mortality across hospitals was explained by variation in use of guideline based care in both countries. Risk of death was higher in hospitals less likely to provide guideline concordant care.
影响因子：
2.2
作者：
Hambraeus, Kristina;Held, Claes;Jernberg, Tomas
通讯作者：
Jernberg, Tomas
影响因子：
158.5
作者：
Jha, AK;Li, ZH;Epstein, AM
通讯作者：
Epstein, AM