How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?
How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?
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DOI：
10.1097/mlr.0000000000000366
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发表时间：
2015-06-01
期刊：
影响因子：
3
通讯作者：
Davenport, Claire
中科院分区：
文献类型：
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作者：
Ripley, Diane C. Cowper;Kwong, Pui L.;Davenport, Claire
目的：检查估计的旅行时间入院和死亡率的退伍军人急性缺血性中风，控制患者的人口统计学，临床，设施水平的变量，以及选择在医院的治疗和procedure.Methods之间的关系：纵向观察人群为基础的研究。对2006年10月1日至2008年9月30日期间从退伍军人管理局医疗中心（VAMC）出院并诊断为缺血性卒中的所有退伍军人的信息进行了检查。共有10，430名患者符合该研究的入选标准。住院期间死亡的患者与存活出院的患者之间的未校正差异，酌情使用卡方（2）分析或Student t检验。多变量逻辑回归用于控制患者、治疗和设施特征的混杂效应，以检查旅行时间和住院死亡率的双变量结果之间的关系。到入院VAMC的旅行时间是我们关注的关于住院死亡率影响的主要变量，在调整患者、治疗、和设施特征表明，较长的旅行时间显着增加了住院死亡率的几率。旅行时间>= 90分钟的住院死亡率增加（OR = 1.476; 95%CI，1.067-2.042），
Objective: To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures.Methods: A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used chi(2) analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.Results: Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times >= 90 minutes had increased odds of inhospital mortality (OR = 1.476; 95% CI, 1.067-2.042) as compared with