美国退伍军人心力衰竭护理质量的地理差异
Revanth S Kosaraju1, Gregg C Fonarow2, Michael K Ong3
1Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Electronic address: https://twitter.com/revanthsk12.
JACC. Heart failure
|August 5, 2023
概括
心力衰竭与减少喷射率 (HFrEF) 护理存在地理差异. 需要有针对性的战略来改善在服务不足地区的指南导向医疗疗 (GDMT) 处方.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 全球心力衰竭 (HF) 的患病率正在增加.
- 有证据表明,指南导向医学疗法 (GDMT) 可以减少心力衰竭患者的不良结果,减少排气分数 (HFrEF).
- 在HFrEF护理质量的地理差异还不太清楚.
研究的目的:
- 在退伍军人卫生管理局 (VHA) 中评估对HFrEF的GDMT处方的国家差异.
- 为了确定在GDMT处方和社会经济因素的地理差异之间的潜在关联.
主要方法:
- 确定了一组美国退伍军人患有HFrEF.
- 患者地址与医院转诊区域 (HRR) 有关.
- 分析了从2020年7月到2021年7月的GDMT处方数据. 在HRR中计算了复合GDMT得分和处方率. 通过choropleth地图可视化地理变异,并通过线性回归评估与人口因素的关联.
主要成果:
- 在HRR中观察到GDMT处方率和复合得分的显著地理差异.
- 处方率因药物类别而异,β-阻断剂是最常见的 (80%) 和血管激素受体-neprilysin抑制剂是最少的 (12.2%).
- 较低的GDMT绩效与更高的收入不平等 (吉尼系数) 和更高的低收入居民在HRR中的百分比有关.
结论:
- 在VHA中,HFrEF护理质量,特别是GDMT处方的实质性地理差异很明显.
- 需要有针对性的干预措施,以改善GDMT在表现较差的地区的普及,特别是那些面临贫困和收入不平等等社会经济挑战的地区.
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