相关实验视频
医疗保险受益人入院至关键门户和非关键门户医院的死亡率,2002-2010年
Karen E Joynt1, E John Orav, Ashish K Jha
1Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA. kjoynt@partners.org
JAMA
|April 4, 2013
概括
2002年,临界接入医院 (CAH) 的医疗保险患者的死亡率与其他医院相似. 到2010年,CAH死亡率上升,与非CAH患者的下降率相差,表明需要采取质量改善举措.
科学领域:
- 医疗服务研究 医疗服务研究
- 农村卫生 农村卫生
- 提高质量 提高质量
背景情况:
- 临界接入医院 (CAH) 对农村医疗保健至关重要,但面临资源限制和弱势患者群体.
- 在过去十年中,CAH患者的比较患者结果和死亡率趋势以前是未知的.
- 了解这些趋势对于评估农村医疗保健机构的护理质量至关重要.
研究的目的:
- 评估在临界接入医院 (CAH) 治疗的患者的死亡率趋势.
- 将这些死亡率趋势与非CAHs中观察到的趋势进行比较.
- 评估2002年至2010年期间针对特定疾病的30天死亡率的变化.
主要方法:
- 使用医疗保险服务费用数据的回顾性观察性研究.
- 分析包括190万例急性心肌梗塞,450万例充血性心力衰竭和3900万例肺炎入院病例.
- 从2002年到2010年,CAH和其他美国急症护理医院之间的风险调整后30天死亡率进行了比较.
主要成果:
- 2002年,CAH患者在研究条件下与非CAH患者的30天死亡率相似.
- 在2002年至2010年期间,CAH的死亡率每年增加 (0.1%),而非CAH的死亡率则下降 (-0.2%).
- 到2010年,与非CAH相比,CAH的死亡率显著上升 (1.8%的差异),这一趋势在个体疾病和小型农村医院中一致.
结论:
- 对于急性心肌梗塞,充血性心力衰竭或肺炎的Medicare受益人来说,30天死亡率在2002年至2010年间与其他急性护理医院相比,在CAH中增加.
- 这些发现表明,患者治疗结果的差距越来越大,CAH患者的死亡率趋势越来越严重.
- 新的质量改善策略可能是必要的,以应对临床医院不断上升的死亡率.
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