对医院和心脏病专家的冠状动脉血管塑造体积-结果关系
1State University of New York at Albany, 12144-3456, USA.
JAMA
|March 19, 1997
概括
通过皮肤进行透光冠状动脉血管塑造 (PTCA) 的医院和心脏病学家数量较高与更好的患者结果有关. 增加的手术体积与较低的住院死亡率和冠状动脉旁路移植手术率有关.
科学领域:
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
- 干预心脏病学 干预心脏病学
背景情况:
- 提供者数量是医疗保健质量的关键因素.
- 评估医院和心脏病学家手术量对患者结果的影响对于质量改善至关重要.
研究的目的:
- 为了评估每年医院和心脏病学家之间的协会,皮肤透光冠状动脉血管形成术 (PTCA) 的数量.
- 确定PTCA体积与住院死亡率以及同期冠状动脉旁路移植 (CABG) 手术率之间的关系.
主要方法:
- 一项使用纽约州卫生部冠状动脉血管成形报告系统 (1991-1994) 数据的队列研究.
- 包括62,670名在纽约州31家医院接受PTCA的患者.
- 分析了住院死亡率和同住CABG手术率作为主要结局.
主要成果:
- 整体住院死亡率为0.90%,同一住院CABG率为3.43%.
- 较低的医院PTCA体积 (<600) 与显著更高的死亡率 (0.96%) 和CABG率 (3.92%) 相关.
- 较低的心脏病学家PTCA体积 (<75) 也显示出明显更高的死亡率 (1.03%) 和CABG率 (3.93%).
结论:
- 医院和心脏病学家PTCA体积都与住院死亡率和同一住院CABG手术率有显著的反向关系.
- 较高的PTCA程序体积与改善的患者安全和结果有关.
- 这些发现支持了体积与结果关系在干预性心脏病学中的重要性.
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