急性大动脉剖析的运输模型:对减少治疗中心的影响
Amelie Goehlich1,2, Paul Prasse3, Lisa Zaschke2
1Charité Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, 10117 Berlin, Germany - Universitätsmedizin Berlin, Berlin, Charitéplatz 1, 10117 Berlin, Germany.
概括
将急性A型大动脉剖析治疗巩固到更少的中心可以降低死亡率. 这一战略侧重于每家中心的更高的年产量,超过了患者运输时间的增加.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 医学经济学 医学经济学
背景情况:
- 急性A型大动脉剖析需要及时的外科干预.
- 在高人数中心集中护理可以改善结果.
- 减少治疗中心对德国治疗机会和结果的影响尚未完全被理解.
研究的目的:
- 模拟较少的急性甲型大动脉剖析治疗中心对临床前运输的影响.
- 评估德国集中治疗在治疗时间方面的可行性.
- 评估中心体积和住院死亡率之间的关系.
主要方法:
- 利用来自德国心脏手术中心 (n=76) 和国家统计数据 (2005-2015) 的数据.
- 模型运输距离和时间使用谷歌地图进行患者转移.
- 分析了与急性A型大动脉解剖中心年平均体积相关的住院死亡率 (n=14,102).
主要成果:
- 观察到76个中心的平均运输距离为27.13公里,时间为35.78分钟.
- 将中心减少到12个可以通过加倍的运输时间 (70分钟) 实现.
- 较高的年体积 (>25-30) 与较低的住院死亡率 (P < 0.001) 有关.
结论:
- 将急性A型大动脉剖析护理集中到较少,大量的中心,可以提高生存率.
- 降低死亡率的好处超过了延长的运输时间.
- 实施量-结果关系对于优化护理提供至关重要.
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