Differences in quality of care among patients hospitalized with atrial fibrillation as primary or secondary cause for admission
Differences in quality of care among patients hospitalized with atrial fibrillation as primary or secondary cause for admission
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DOI：
10.1093/intqhc/mzi026
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发表时间：
2005-06-01
影响因子：
2.6
通讯作者：
Mehta, RH
中科院分区：
文献类型：
--
作者：
Lim, MJ;Roychoudhury, C;Mehta, RH
Objective.有几个因素与房颤（AF）患者护理质量的变化有关。主要因AF（AF的初步诊断）而不是另一种主要诊断但合并AF（AF的次要诊断）住院是否影响AF的护理质量尚不清楚。因此，我们试图评估初次诊断与二次诊断房颤的医疗保险患者的护理质量差异。设计和设置。我们研究了一个随机抽样的医疗保险按服务收费出院从密歇根州的急性护理医院超过1年的时间与AF的主要或次要诊断（ICD-9-CM 427.31）。在放电时的战争用途。在研究的5993名患者中，772名患者被初步诊断为AF，5221名患者被二次诊断为AF。二次诊断为AF的患者年龄较大，更可能是男性，并且不太可能患有高血压。与初步诊断为AF的“理想”患者（n = 363）相比，次要诊断为AF的抗凝治疗“理想”患者（n = 1648）接受华法林治疗的可能性较小（52.6% vs. 59.8%，P < 0.001）。继发性房颤患者对检测指标的依从性较低。AF的次要诊断而不是AF作为主要诊断似乎是大多数住院的AF医疗保险患者的原因。尽管继发性房颤患者的护理质量较低，但两组房颤患者都存在质量改善的机会。
Objective. Several factors have been linked to the variation in the quality of care for patients with atrial fibrillation (AF). Whether hospitalization primarily for AF (primary diagnosis of AF) as opposed to another primary diagnosis but having concomitant AF (secondary diagnosis of AF) impacts quality of care for AF is not known. Accordingly, we sought to evaluate the differences in quality of care of Medicare patients admitted with primary diagnosis versus secondary diagnosis of AF.Design and setting. We studied a random sample of Medicare fee-for-service discharges from Michigan's acute care hospitals over a 1-year period with a primary or secondary diagnosis of AF (ICD-9-CM 427.31).Main outcome measure. Warfarin use at the time of discharge.Results. Of 5993 patients in the study, 772 had a primary diagnosis of AF and 5221 had a secondary diagnosis of AF. Patients with a secondary diagnosis of AF were older, more likely to be male, and less likely to be hypertensive. Patients with a secondary diagnosis of AF 'ideal' for anticoagulation (n = 1648) were less likely to receive warfarin compared with 'ideal' patients with primary diagnosis of AF (n = 363) (52.6% versus. 59.8%, P < 0.001). Adherence to test indicators was lower in patients with secondary diagnosis of AF.Conclusion. Secondary diagnosis of AF rather than AF as a primary diagnosis appears to account for most Medicare patients with AF admitted to hospitals. Whereas quality of care is lower in patients with secondary diagnosis of AF, opportunity for quality improvement exists for both groups of patients with AF.