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联盟表和急性心肌梗塞
1Public Health Research Unit, University of Glasgow, UK. a.leyland@udcf.gla.ac.uk
Lancet (London, England)
|March 11, 1998
概括
医院的表现取决于患者的特点,而不仅仅是位置. 调整患者因素对于准确比较急性心肌梗塞结果至关重要. 有效的比较可以建立公众对医疗保健的信任.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 对比医院的结果变得越来越重要.
- 区分医院实践影响和患者特征对于准确的结果评估至关重要.
- 这项研究重点关注苏格兰急性心肌梗塞 (AMI) 后的死亡.
研究的目的:
- 调查急性心肌梗塞 (AMI) 医院结局的变化.
- 区分患者相关因素和影响死亡率的医院特定因素.
- 评估地理居住对AMI结果的影响.
主要方法:
- 使用了一组数据集,包括1992年12月至1993年11月在苏格兰发生的14359次AMI发作.
- 分析了死亡记录,包括发生在医院内和出院后30天内的死亡记录,以及医院以外的死亡记录.
- 采用多层模型来估计可归因于患者特征,医院和居住地区的影响.
主要成果:
- 观察到医院死亡率的显著差异,受患者年龄,性别和病史的影响.
- 与苏格兰平均水平相比,死亡几率在各医院之间差异很大.
- 在考虑住所地区和详细的患者信息后,在70岁以上的患者中没有发现显著的医院差异.
- 根据邮政编码地区,在医院外死亡和医院内或出院后死亡之间发现了强烈的关联.
结论:
- 医院的结果应该独立于患者居住的地区进行评估.
- 患者子组可能会经历不同的结果,需要对子组进行特定评估.
- 不准确的绩效指标可能会削弱公众对医院服务的信任.
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