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通过设施穿皮冠状动脉干预能力对ST升高心肌梗塞的未保险患者的初始治疗

Sara Lin¹, Andrew Shermeyer², Sayeh Nikpay²

¹Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

|November 3, 2023

概括

没有保险的ST升高心肌梗塞 (STEMI) 患者不太可能在具有PCI能力的设施接受初始治疗. 这表明,在无保险者获得及时,高质量的STEMI护理方面存在潜在的差异.

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
健康公平卫生公平

背景情况:

及时的再输血对于降低ST升高心肌梗塞 (STEMI) 的发病率和死亡率至关重要.
具有穿皮冠状动脉干预 (PCI) 能力的设施对于STEMI病例的快速转血至关重要.
了解影响初级护理获得的因素对于改善STEMI结果至关重要.

研究的目的:

调查成人STEMI患者在PCI能力设施中的保险状况和初始急诊部 (ED) 护理之间的关联.
根据保险覆盖,确定获得时间敏感的STEMI治疗的潜在差异.

主要方法:

使用加利福尼亚州卫生保健准入和信息数据库 (2011-2019) 部门的回顾性横截面研究.
包括患有STEMI (国际疾病分类代码) 的成年患者.
多变量后勤回归分析了主要结果 (PCI-能够设施的初始护理),以保险状况作为主要暴露,控制患者,设施和时间因素.

主要成果:

对135,358次符合条件的STEMI访问进行分析.
没有保险的患者在能够接受PCI的设施中获得初始治疗的几率明显较低 (调整后的几率比为0.62,95%CI为0.54-0.72,p <0.001).
在所有灵敏度分析中,结果保持一致.

结论:

没有保险的STEMI患者不太可能在具有PCI能力的设施中接受初始护理.
调查结果表明,在没有保险的个人获得高质量,时间敏感的STEMI治疗方面存在潜在的差异.
需要进一步的研究和干预措施来解决这些访问差距.

关键词:

ST升高心肌梗塞的心脏病发作紧急护理紧急护理设施的能力设施能力.卫生政策卫生政策通过皮肤进行冠状动脉干预.

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