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題 名 | The Association between Hospital Quality of Care and Short-term Mortality of Acute Myocardial Infarction Patients=醫院照護過程品質與急性心肌梗塞病人死亡之相關性 |
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作 者 | 譚家惠; 譚醒朝; 楊銘欽; | 書刊名 | 臺灣公共衛生雜誌 |
卷 期 | 32:3 2013.06[民102.06] |
頁 次 | 頁289-301 |
分類號 | 419.73 |
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; |
語 文 | 英文(English) |
中文摘要 | 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。 |
英文摘要 | 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. |
本系統中英文摘要資訊取自各篇刊載內容。