局部诊断测试强度与侵袭性心脏手术之间的关联
D E Wennberg1, M A Kellett, J D Dickens
1Division of Health Services Research, Department of Medicine, Maine Medical Center, Portland 04107, USA.
JAMA
|April 17, 1996
概括
侵袭性心脏手术的地理差异在很大程度上可以通过诊断测试强度来解释. 当地压力测试的使用强烈地预测了医疗保险受益者的冠状动脉血管学和再血管化率.
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
- 医学经济学 医学经济学
背景情况:
- 在使用侵袭性心脏手术方面存在地理差异.
- 诊断测试在驱动这些变异中的作用尚未完全理解.
研究的目的:
- 调查诊断测试和侵袭性心脏手术之间的关系.
- 为了确定诊断测试是否解释了手术频率的地理差异.
主要方法:
- 基于人口的队列研究,使用来自新英格兰北部的医疗保险B部分数据.
- 分析了12个服务领域的压力测试,冠状动脉血管学和再血管化利用率.
- 线性回归用于评估程序类别之间的关系,不包括干预后执行的测试.
主要成果:
- 在总压力测试率和随后的冠状动脉血管学 (R2=0.61) 之间观察到强烈的正相关性.
- 影像压力测试显著解释了血管造影率的差异 (R2=0.50).
- 冠状动脉扫描强烈预测了复血管化率 (R2=0.82),压力测试也与复血管化有关 (R2=0.55).
结论:
- 诊断测试率在很大程度上解释了随后的侵袭性心脏手术的变化.
- 当地测试强度是影响心脏干预使用的关键因素.
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