国家中风系统和护理法律对中风结果的影响
Erika B Fulmer1, Dana Keener Mast2, Lucas Godoy Garraza2
1Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop MS-S107-1, Atlanta, GA 30341, USA.
Healthcare (Basel, Switzerland)
|November 14, 2023
概括
脑卒中护理系统 (SSOC) 法律改善了对初级脑卒中中心的准入,并降低了脑卒中死亡率和成本. 然而,这些法律并没有减少中风结果的种族或农村差异.
科学领域:
- 公共卫生 公共卫生
- 卫生政策 卫生政策
- 紧急医疗 紧急医疗
背景情况:
- 自2003年以来,美国许多州已经制定了加强中风护理系统 (SSOC) 的立法.
- 这些SSOC法律对中风结果的影响仍然是研究的关键领域.
研究的目的:
- 估计SSOC法律对美国中风结果的影响.
- 分析SSOC政策与获得护理,死亡率和治疗及时性之间的关联.
主要方法:
- 使用自然实验设计与纵向建模.
- 分析了SSOC法律 (2003-2018) 的编码法律数据集,国家中风认证数据 (1997-2018),医疗保健成本和利用项目的数据 (2012-2018),以及国家生命统计系统数据 (1979-2019).
主要成果:
- 拥有SSOC政策的州显示,获得初级中风中心的机会有所改善 (2.7-8.0 PP高).
- SSOC法律与更低的住院费用 (每次住院减少610-1724美元) 和降低年龄调整的中风死亡率 (每10万人减少1.0-1.6例死亡) 相联系.
- 较高比例的患者在45分钟内接受脑成像 (3.6-5.0 PP更高),一些州的住院死亡率降低.
结论:
- SSOC立法与中风护理提供和患者结果的显著改善有关.
- 虽然SSOC法律显示出广泛的好处,但它们并没有有效地减少中风死亡率的现有种族和农村差异.
- 需要进一步的研究来解决差异,并完善SSOC政策,以获得公平的影响.
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