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

Objectives: To evaluate the association of six hospital-level process of care measures and　the 30-day mortality. Methods: This is a cross-sectional study. Patients admitted with a principal diagnosis of AMI (ICD-9CM: 410.xx, excluding 410.x2) (n=1,416) between January 2007 and November　2009. Aspirin use during hospitalization, β-blocker use during hospitalization, ACE inhibitor　for 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 using　a hierarchical generalized linear model (HGLM) to examine whether the 30-day mortality at the　patient 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% received　LDL-C testing, 41.37% received lipid lowering medication, and 40.97% received reperfusion　therapy. 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 composite　score of six measures (OR, 0.84; 95% CI, 0.76-0.92) were significantly correlatedwith 30-day　mortality. Conclusions: A significant association between hospital’s process performance and patient　outcome was found. The outcome of AMI patients could be enhanced by improving process　performance. 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-9 CM: 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 inhibitor for 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 inhibitor for 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。