对于急性心肌梗塞患者的初级皮肤冠状动脉干预的区域差异:使用日本国家索赔数据库进行轨迹分析
Hisashi Itoshima1, Jung-Ho Shin1, Noriko Sasaki1
1Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
PloS one
|October 22, 2024
概括
这项研究分析了日本急性心肌梗塞 (AMI) 初级穿皮冠状动脉干预 (pPCI) 的地理差异. 虽然大多数地区的pPCI率保持稳定,但有一组的pPCI率显著增加,突出地区质量差异.
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
- 公共卫生 公共卫生
背景情况:
- 在急性心肌梗塞 (AMI) 护理质量的地理差异已被记录.
- 了解AMI治疗的区域差异对于改善质量至关重要.
研究的目的:
- 评估日本二级医疗区域 (SMA) 中接受初级皮肤穿冠状动脉干预 (pPCI) 的AMI患者比例.
- 确定pPCI率的轨迹,并调查影响区域差异的因素.
主要方法:
- 对日本AMI患者的国家医疗保险索赔数据库 (2014年4月至2020年3月) 的分析.
- 在335个SMA和财政年度中计算pPCI比例.
- 基于组的轨迹建模,以识别pPCI利用的不同模式.
- 调查与已识别的轨迹相关的区域级因素.
主要成果:
- 中位数的pPCI比例从2014财年63.5%增加到2020财年69.6%.
- 确定了四个轨迹组:低至低 (LL),低至中 (LM),中至中 (MM) 和高至高 (HH).
- 较高的人口密度和医生/心脏病学家的可用性与HH和MM组有关.
- 在LM群体中,pPCI率呈现上升趋势,与LL,MM和HH群体的稳定趋势不同.
结论:
- 轨迹分析显示,在SMA患者中,对AMI患者的pPCI利用有明显的模式.
- LM集团的pPCI增长趋势表明,以前表现较差的地区可能会有质量改善的潜力.
- 区域因素显著影响pPCI在AMI护理中的采用和发展轨迹.
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