在加利福尼亚州的ST段升高心肌梗塞的无保险者与保险患者之间的设施间转移
Michael J Ward1,2,3, Sayeh Nikpay4, Andrew Shermeyer4
1Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA network open
|June 9, 2023
概括
没有保险的患有ST段升高心肌梗塞 (STEMI) 的患者在医院之间转移的可能性较低,即使考虑到医院的心脏干预能力. 需要对这些患者的结果进行进一步的研究.
科学领域:
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
背景情况:
- 保险状况影响ST段升高心肌梗塞 (STEMI) 患者的医疗保健准入和结果.
- 穿皮冠状动脉干预 (PCI) 能力在调解无保险STEMI患者转移决策中的作用尚不清楚.
研究的目的:
- 调查无保险的STEMI患者是否比有保险的患者更有可能经历设施间转移.
- 确定一个设施的PCI能力是否会影响保险状态和设施间转移之间的关联.
主要方法:
- 使用加利福尼亚州出院数据 (2010-2019) 的观察性队列研究.
- 对比了有保险和没有保险的STEMI患者到急诊室的情况.
- 多变量后勤回归分析了保险状态和转移之间的关联,调整了PCI能力和其他因素.
主要成果:
- 这项研究包括135358名STEMI患者;24.2%被转移.
- 在对设施PCI能力和患者/医院因素进行调整后,没有保险的患者在设施间转移的几率较低 (aOR,0.93;95%CI,0.88-0.98).
- 在计算PCI容量后,这种关联仍然很重要.
结论:
- 缺乏保险与STEMI患者的医院间转移几率降低有关,即使是在具有PCI能力的医院.
- 研究结果表明,在没有保险的STEMI患者中,转移模式可能存在差异.
- 需要进行进一步的研究,以探索未保险的STEMI患者的设施特征和结果.
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