Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction
Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction
复制标题
DOI：
10.1001/jama.285.24.3116
复制
发表时间：
2001-06-27
影响因子：
120.7
通讯作者：
Chan, BTB
中科院分区：
文献类型：
--
作者：
Tu, JV;Austin, PC;Chan, BTB
背景 急性心肌梗死 (AMI) 是一种常见疾病，由具有不同临床经验水平的医生治疗，但经验水平是否影响结果仍不确定。 目的 评估入院医生治疗的平均每年病例数与 AMI 后死亡率之间的关系。 设计、设置和患者 使用链接的管理数据库进行回顾性队列研究，其中包含 1992 年 4 月 1 日至 3 月期间由 5374 名医生治疗的 98 194 名患者的入院信息。 1998 年 1 月 31 日，加拿大安大略省。 主要结果 AMI 后 30 天和 1 年的死亡率风险率，根据医生数量和患者、医生和医院特征进行调整。 结果 30 天死亡率为 13.5%，1 年死亡率为 21.8%。每年治疗 5 例或更少 AMI 病例（最低四分位）的医生的 30 天风险调整死亡率为 15.3%，而每年治疗 24 例以上 AMI 病例的医生（最高四分位；P）的 30 天风险调整死亡率为 11.8%
Context Acute myocardial infarction (AMI) is a common condition that is treated by physicians with varying levels of clinical experience, but whether the level of experience affects outcome remains uncertain.Objective To evaluate the relationship between the average annual volume of cases treated by admitting physicians and mortality after AMI.Design, Setting, and Patients Retrospective cohort study using linked administrative databases containing patient admission information for 98 194 patients treated by 5374 physicians between April 1, 1992, and March 31, 1998, in Ontario, Canada.Main Outcome Measures Mortality risk rates for 30 days and 1 year post-AMI, adjusted by physician volume and patient, physician, and hospital characteristics.Results The 30-day mortality rate was 13.5% and the 1-year mortality rate was 21.8%, A strong inverse relationship between the average annual volume of AMI cases treated by the admitting physician and mortality after an AMI was observed. The 30-day risk-adjusted mortality rate was 15.3% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 11.8% for physicians who treated more than 24 AMI cases annually (highest quartile; P