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Envío selectivo a hospitales de alto volumen: estimación de muertes potencialmente evitables
R A Dudley1, K L Johansen, R Brand
1Department of Medicine, School of Medicine, and the Institute for Health Policy Studies, University of California, San Francisco, 94118, USA. adudley@itsa.ucsf.edu
JAMA
|March 7, 2000
Resumen
La derivación de pacientes a hospitales de alto volumen (HVH) puede reducir significativamente la mortalidad por afecciones complejas. En California, se estima que 602 muertes podrían evitarse anualmente si se dirigiera la atención a los HVA.
Área de la Ciencia:
- Resultados de la investigación de la atención médica.
- Servicios de salud investigación servicios de salud.
- El análisis de los resultados quirúrgicos.
Sus antecedentes:
- La evidencia sugiere que los hospitales de alto volumen (HVH) tienen tasas de mortalidad más bajas que los hospitales de bajo volumen (LVH) para procedimientos específicos.
- A pesar de esta evidencia, la derivación de pacientes a HVH sigue siendo limitada en la práctica.
- Esta brecha pone de relieve la necesidad de investigar los beneficios potenciales de una mayor utilización de HVH.
Objetivo del estudio:
- Para cuantificar la diferencia en la mortalidad hospitalaria entre HVH y LVH para condiciones con datos robustos.
- Para estimar el número de muertes en California que podrían evitarse mediante la remisión de pacientes a HVHs.
Principales métodos:
- Una búsqueda exhaustiva de la literatura (1983-1998) identificó estudios sobre el volumen hospitalario y la mortalidad.
- Se seleccionó el estudio de mayor calidad para cada afección para calcular los odds ratios (ORs) para la mortalidad hospitalaria.
- Estos quirófanos se aplicaron a la base de datos de alta hospitalaria de California de 1997 para estimar las muertes evitables.
Principales resultados:
- La mortalidad fue significativamente menor en los HVH para 11 afecciones complejas, incluidas varias cirugías y el tratamiento del VIH / SIDA.
- En California, 58.306 pacientes con estas afecciones fueron tratados en LVHs en 1997.
- Un estimado de 602 muertes (95% IC, 304-830) en LVH fueron atribuibles al bajo volumen hospitalario.
Conclusiones:
- Facilitar la derivación de pacientes a HVHs ofrece un potencial significativo para reducir la mortalidad hospitalaria general en California para las condiciones identificadas.
- Se necesita más investigación para evaluar la viabilidad de las estrategias de derivación selectiva y sus posibles consecuencias.
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