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題名：The Association between Hospital Quality of Care and Short-term Mortality of Acute Myocardial Infarction Patients
書刊名：臺灣公共衛生雜誌
作者：譚家惠 引用關係／譚醒朝 引用關係／楊銘欽
作者(外文)：Tan, Chia-hui／Tam, Sing-chew／Yang, Ming-chin
出版日期：2013
卷期：32:3
頁次：頁289-301
主題關鍵詞：照護品質；急性心肌梗塞；醫院照護過程；廣義階層線性模式；Quality of care；Acute myocardial infarction；AMI；Hospital process performance；Hierarchical generalized linear model；HGLM
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(2) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:2
  • 共同引用共同引用:0
  • 點閱點閱:16
目標：評估急性心肌梗塞6項醫院照護過程品質測量與病人出院後30天內死亡情形之相關性。方法：採橫斷性研究，以2007年1月至2009年11月住院主診斷為急性心肌梗塞病人(ICD-9CM: 410.xx)，排除後續治療者(ICD-9 CM: 410.x2)，以廣義階層線性模式(HGLM)分析醫院層次的6項照護過程品質測量，對於病人出院後30天內死亡情形之相關性。結果：約85.5%的病人在住院期間曾接受aspirin治療、38.32%曾接受beta-blocker治療、46.75%曾接受ACE inhibitorfor LVSD治療、43.91%曾接受低密度膽固醇檢查、41.37%曾接受血管再通術。經病人特質與醫院特質校正後，醫院住院期間beta-blocker使用情形(OR, 0.87; 95% CI, 0.83-0.92)、ACE inhibitorfor LVSD使用情形(OR, 0.93; 95% CI, 0.87-0.99)、低密度膽固醇檢查執行情形(OR, 0.87; 95%CI, 0.81-0.93)、血管再通術使用情形(OR, 0.87; 95% CI, 0.81-0.93)，以及6項品質測量的綜合分數(OR, 0.84; 95% CI, 0.76-0.92)，對於病人出院後30天內死亡風險有顯著影響。結論：醫院照護過程品質測量對於急性心肌梗塞病人出院後30天內死亡風險有顯著影響，且醫院層次照護過程品質測量的應用與改善，將有助於急性心肌梗塞病人照護結果。
Objectives: To evaluate the association of six hospital-level process of care measures andthe 30-day mortality. Methods: This is a cross-sectional study. Patients admitted with a principaldiagnosis of AMI (ICD-9CM: 410.xx, excluding 410.x2) (n=1,416) between January 2007 and November2009. Aspirin use during hospitalization, β-blocker use during hospitalization, ACE inhibitorfor LVSD use during hospitalization, LDL-c testing, lipid lowering medication, and reperfusiontherapy. Outcome included the 30-day mortality of AMI patients. Data were analysed by usinga hierarchical generalized linear model (HGLM) to examine whether the 30-day mortality at thepatient level varied among different hospital performance adjusted for patient and hospital characteristics.Results: Among those patients, 88.50% received aspirin therapy during hospitalization,38.32% received β-blocker therapy, 46.75% received ACE inhibitor for LVSD, 43.91% receivedLDL-C testing, 41.37% received lipid lowering medication, and 40.97% received reperfusiontherapy. Overall the 6 quality of care measures were 53.7% of ideal instances. After risk adjustment,β-blocker use during hospitalization (odds ratio [OR], 0.87; 95% confidence interval [CI],0.83-0.92), ACE inhibitor for LVSD (OR, 0.93; 95% CI, 0.87-0.99), lipid lowering medication(OR, 0.91; 95% CI, 0.86-0.96), reperfusion therapy (OR, 0.87; 95% CI, 0.81-0.93) and compositescore of six measures (OR, 0.84; 95% CI, 0.76-0.92) were significantly correlated with 30-daymortality. Conclusions: A significant association between hospital’s process performance and patientoutcome was found. The outcome of AMI patients could be enhanced by improving processperformance.
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圖書
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其他
1.National Health Insurance Research Database。Data subsets，http://w3.nhri.org.tw/nhird/en/Data_Subsets.html#S3， 2010/07/28。  new window
 
 
 
 
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