选择性转移到大量医院:估计可能可以避免的死亡人数
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
概括
将患者转移到大量医院 (HVHs) 可以显著降低复杂疾病的死亡率. 在加利福尼亚州,每年估计有602例死亡可能会被避免,只要将护理指向HVHs.
科学领域:
- 医疗保健研究成果研究结果
- 医疗服务研究 医疗服务研究
- 手术后果分析手术后果分析
背景情况:
- 有证据表明,高容量医院 (HVHs) 的死亡率低于低容量医院 (LVHs) 的特定程序.
- 尽管有这些证据,但在实践中,将患者转移到HVH仍然有限.
- 这一差距凸显出需要研究增加高温暖气利用的潜在好处.
研究的目的:
- 量化HVH和LVH之间医院死亡率的差异,以获得可靠的数据.
- 为了估计加利福尼亚州的死亡人数,可以通过将患者转移到HVHs来预防.
主要方法:
- 一个全面的文献搜索 (1983-1998) 确定了有关医院体积和死亡率的研究.
- 对于每个疾病,选择了最优质的研究,以计算住院死亡率的几率比率 (ORs).
- 这些OR被应用到1997年加利福尼亚州医院出院数据库,以估计可避免的死亡.
主要成果:
- 在11种复杂疾病中,HVH的死亡率显著降低,包括各种手术和艾滋病毒/艾滋病治疗.
- 在加利福尼亚州,有58,306名患有这些疾病的患者在1997年在LVHs接受治疗.
- 据估计,在LVH患者中,602例死亡 (95% CI,304-830) 是由于医院人数较少而导致的.
结论:
- 促进患者转诊HVH提供了显著的潜力,以减少加利福尼亚州的医院总体死亡率鉴定条件.
- 需要进一步的研究来评估选择性推策略的可行性及其潜在后果.
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