2001～2011年我国中部农村地区急性心肌梗死患者住院时长及影响因素研究
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摘要
目的评价2001～2011年我国中部农村地区急性心肌梗死(AMI)住院患者的住院时长及变化趋势,并探究影响住院时长的因素。方法研究采用两阶段随机抽样的方法,抽取2001、2006和2011年我国中部农村地区35家医院AMI住院患者的病历资料。描述AMI患者的平均住院时长及十年变化趋势,并根据住院时长中位数将医院划分为高中低三类,比较其患者特征、院内诊疗和结局差异,探究医院特征对住院时长的影响。结果本研究共计1475例AMI住院患者纳入研究。2001、2006、2011年的平均住院时长分别为(11.2±6.5)d、(10.6±8.2)d及(11.0±5.9)d,三个年份的住院时长差异及其时间趋势检验无统计学意义。进一步调整患者水平特征后,仍无统计学差异。住院时长高中低三类医院的AMI患者基线特征仅在高血压病史、自发病至入院时间、入院胸痛及现患肺炎上存在统计学差异。诊疗上中住院时长医院肌酸激酶同工酶(CK-MB)检测率最低(60.2%,P=0.010),低住院时长医院患者入院24 h内肝素使用率最低(68.0%,P=0.003),而住院事件发生率在三类医院间无统计学差异。教学医院及AMI治疗规模小于30例/年的医院AMI患者住院时长更短。结论我国中部农村地区AMI住院患者的平均住院时长总体较长且十年来无明显改善。全面合理的缩短住院时长,最优化利用有限的资源为患者提供高质量的医疗服务是当务之需。
Objective This study described the hospital length of stay(LOS) for acute myocardial infraction(AMI patients and its time trend between 2001 and 2011 in central rural area of China, explored the factors influencing the LOS. Method The study used a two-stage random sampling design to select patients admitted to 35 hospitals for AMI in 3 years(2001, 2006, and 2011) from central rural area of China. Patient information was obtained from medical records. Average LOS and its time trend in last decade were described. Hospitals were divided into 3 groups according to the median of LOS and patient characteristics, treatments and outcomes were compared across hospitals. Multivariate generalized linear model was used for testing the association between hospital level characteristics and LOS. Result1475 AMI cases were included in the analysis. The mean LOS were respectively,(11.2±6.5) d in 2001,(10.6±8.2) d in 2006, and(11.0±5.9) d in 2011, without significant difference or time trend. After adjusted for patients' characteristics, there were no significant difference between years either. Patients characteristics were significantly different in history of hypertension, symptom onset to admission, chest pain, and pneumonia among high-, middleand low-LOS hospitals. The detection rate of CK-MB was the lowest in middle-LOS hospitals(60.2%, P=0.010),and the use rate of heparin was the lowest in patients from low-LOS hospitals within 24 hours after admission(68.0%,P=0.003). There was no significant difference in diagnosis, treatment and outcomes among 3 hospital groups except for CK-MB diagnostic tests and heparin medication within 24 hours. Teaching hospitals and hospitals with relatively small AMI inpatient treatment volumes(<30 annually) tended to have shorter LOS. Conclusion LOS in central rural area of China remained long compared with international standards and didn't show a marked decline over the past decade.It's critical to further shorten LOS to make the best use of limited medical resources for AMI patients.
Objective This study described the hospital length of stay(LOS) for acute myocardial infraction(AMI patients and its time trend between 2001 and 2011 in central rural area of China, explored the factors influencing the LOS. Method The study used a two-stage random sampling design to select patients admitted to 35 hospitals for AMI in 3 years(2001, 2006, and 2011) from central rural area of China. Patient information was obtained from medical records. Average LOS and its time trend in last decade were described. Hospitals were divided into 3 groups according to the median of LOS and patient characteristics, treatments and outcomes were compared across hospitals. Multivariate generalized linear model was used for testing the association between hospital level characteristics and LOS. Result1475 AMI cases were included in the analysis. The mean LOS were respectively,(11.2±6.5) d in 2001,(10.6±8.2) d in 2006, and(11.0±5.9) d in 2011, without significant difference or time trend. After adjusted for patients' characteristics, there were no significant difference between years either. Patients characteristics were significantly different in history of hypertension, symptom onset to admission, chest pain, and pneumonia among high-, middleand low-LOS hospitals. The detection rate of CK-MB was the lowest in middle-LOS hospitals(60.2%, P=0.010),and the use rate of heparin was the lowest in patients from low-LOS hospitals within 24 hours after admission(68.0%,P=0.003). There was no significant difference in diagnosis, treatment and outcomes among 3 hospital groups except for CK-MB diagnostic tests and heparin medication within 24 hours. Teaching hospitals and hospitals with relatively small AMI inpatient treatment volumes(<30 annually) tended to have shorter LOS. Conclusion LOS in central rural area of China remained long compared with international standards and didn't show a marked decline over the past decade.It's critical to further shorten LOS to make the best use of limited medical resources for AMI patients.
引文
[1]Abajobir AA,Abate KH,Abbafati C,et al.Global,regional,and national disability-adjusted life-years(DALYs)for 333 diseases and injuries and healthy life expectancy(HALE)for 195 countries and territories,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet,2017,390(10100):1260-344.
[2]国家心血管病中心.中国心血管病报告2017[M].北京:中国大百科全书出版社,2018.
[3]中华人民共和国国家卫生和计划生育委员会.中国卫生和计划生育年鉴2016[M].北京:中国协和医科大学出版社,2017.
[4]中华人民共和国国家统计局.中国统计年鉴2017[M].北京:中国统计出版社;2018.
[5]刘晓婷,李镒冲,姜勇,等.2010年我国急性心肌梗死疾病负担分析[J].中国慢性病预防与控制,2013,21(3):271-3.
[6]Wang J,Ma JJ,Liu J,et al.Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China[J].Int J Med Sci,2017,14(3):201.
[7]Saczynski JS,Lessard D,Spencer FA,et al.Declining length of stay for patients hospitalized with AMI:impact on mortality and readmissions[J].Am J Med,2010,123(11):1007-15.
[8]Berger AK,Duval S,Jacobs DR,et al.Relation of length of hospital stay in acute myocardial infarction to postdischarge mortality[J].The American Journal of Cardiology,2008,101(4):428-34.
[9]Tran HV,Lessard D,Tisminetzky MS,et al.Trends in Length of Hospital Stay and the Impact on Prognosis of Early Discharge After a First Uncomplicated Acute Myocardial Infarction[J].Am J Cardiol,2018,121(4):397-402.
[10]Mark DB,Newby LK.Early hospital discharge after uncomplicated myocardial infarction:are further improvements possible?[J].Eur Heart J,2003,24(18):1613-5.
[11]Li J,Li X,Wang Q,et al.ST-segment elevation myocardial infarction in China from 2001 to 2011(the China PEACE-Retrospective Acute Myocardial Infarction Study):a retrospective analysis of hospital data[J].Lancet,2015,385:441-51.
[12]Dharmarajan K,Li J,Li X,et al.The China Patient-Centered Evaluative Assessment of Cardiac Events(China PEACE)retrospective study of acute myocardial infarction:study design[J].Circ Cardiovasc Qual Outcomes,2013,6(6):732-40.
[13]Li Q,Lin Z,Masoudi FA,et al.National trends in hospital length of stay for acute myocardial infarction in China[J].BMC Cardiovascular Disorders.2015,15:9.
[14]Kociol RD,Lopes RD,Clare R,et al.International variation in and factors associated with hospital readmission after myocardial infarction[J].JAMA,2012,307(1):66-74.
[15]Zhang Z,Pack Q,Squires RW,et al.Availability and characteristics of cardiac rehabilitation programmes in China[J].Heart Asia,2016,8(2):9-12.
[16]Jin H,Wei Q,Chen L,et al.Obstacles and alternative options for cardiac rehabilitation in Nanjing,China:an exploratory study[J].BMC Cardiovasc Disord,2014,14:20.
[17]Wang W,Chair SY,Thompson DR,et al.Health care professionals'perceptions of hospital-based cardiac rehabilitation in mainland China:an exploratory study[J].J Clin Nurs,2009,18(24):3401-8.
[18]卫生部.关于建立新型农村合作医疗制度意见的通知[EB/OL].2004.
[19]卫生部.关于中央财政资助中西部地区农民参加新型农村合作医疗制度补助资金拨付有关问题的通知[EB/OL].2004.
[20]Zhang L,Cheng X,Tolhurst R,et al.How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?[J].Trop Med Int Health,2010,15(4):468-75.
[21]Zhan L,Masoudi FA,Li X,et al.Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction,2001 to 2011:China PEACE-Retrospective AMI Study[J].PLoS One,2015,10(4):e0122237.
[22]Zhang L,Desai NR,Li J,et al.National Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction(AMI)in 2006 and 2011:Insights From the China PatientCentered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study[J].J Am Heart Assoc,2015,4(7).
[23]Allison JJ,Kiefe CI,Weissman NW,et al.Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI[J].JAMA,2000,284(10):1256-62.
[2]国家心血管病中心.中国心血管病报告2017[M].北京:中国大百科全书出版社,2018.
[3]中华人民共和国国家卫生和计划生育委员会.中国卫生和计划生育年鉴2016[M].北京:中国协和医科大学出版社,2017.
[4]中华人民共和国国家统计局.中国统计年鉴2017[M].北京:中国统计出版社;2018.
[5]刘晓婷,李镒冲,姜勇,等.2010年我国急性心肌梗死疾病负担分析[J].中国慢性病预防与控制,2013,21(3):271-3.
[6]Wang J,Ma JJ,Liu J,et al.Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China[J].Int J Med Sci,2017,14(3):201.
[7]Saczynski JS,Lessard D,Spencer FA,et al.Declining length of stay for patients hospitalized with AMI:impact on mortality and readmissions[J].Am J Med,2010,123(11):1007-15.
[8]Berger AK,Duval S,Jacobs DR,et al.Relation of length of hospital stay in acute myocardial infarction to postdischarge mortality[J].The American Journal of Cardiology,2008,101(4):428-34.
[9]Tran HV,Lessard D,Tisminetzky MS,et al.Trends in Length of Hospital Stay and the Impact on Prognosis of Early Discharge After a First Uncomplicated Acute Myocardial Infarction[J].Am J Cardiol,2018,121(4):397-402.
[10]Mark DB,Newby LK.Early hospital discharge after uncomplicated myocardial infarction:are further improvements possible?[J].Eur Heart J,2003,24(18):1613-5.
[11]Li J,Li X,Wang Q,et al.ST-segment elevation myocardial infarction in China from 2001 to 2011(the China PEACE-Retrospective Acute Myocardial Infarction Study):a retrospective analysis of hospital data[J].Lancet,2015,385:441-51.
[12]Dharmarajan K,Li J,Li X,et al.The China Patient-Centered Evaluative Assessment of Cardiac Events(China PEACE)retrospective study of acute myocardial infarction:study design[J].Circ Cardiovasc Qual Outcomes,2013,6(6):732-40.
[13]Li Q,Lin Z,Masoudi FA,et al.National trends in hospital length of stay for acute myocardial infarction in China[J].BMC Cardiovascular Disorders.2015,15:9.
[14]Kociol RD,Lopes RD,Clare R,et al.International variation in and factors associated with hospital readmission after myocardial infarction[J].JAMA,2012,307(1):66-74.
[15]Zhang Z,Pack Q,Squires RW,et al.Availability and characteristics of cardiac rehabilitation programmes in China[J].Heart Asia,2016,8(2):9-12.
[16]Jin H,Wei Q,Chen L,et al.Obstacles and alternative options for cardiac rehabilitation in Nanjing,China:an exploratory study[J].BMC Cardiovasc Disord,2014,14:20.
[17]Wang W,Chair SY,Thompson DR,et al.Health care professionals'perceptions of hospital-based cardiac rehabilitation in mainland China:an exploratory study[J].J Clin Nurs,2009,18(24):3401-8.
[18]卫生部.关于建立新型农村合作医疗制度意见的通知[EB/OL].2004.
[19]卫生部.关于中央财政资助中西部地区农民参加新型农村合作医疗制度补助资金拨付有关问题的通知[EB/OL].2004.
[20]Zhang L,Cheng X,Tolhurst R,et al.How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?[J].Trop Med Int Health,2010,15(4):468-75.
[21]Zhan L,Masoudi FA,Li X,et al.Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction,2001 to 2011:China PEACE-Retrospective AMI Study[J].PLoS One,2015,10(4):e0122237.
[22]Zhang L,Desai NR,Li J,et al.National Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction(AMI)in 2006 and 2011:Insights From the China PatientCentered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study[J].J Am Heart Assoc,2015,4(7).
[23]Allison JJ,Kiefe CI,Weissman NW,et al.Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI[J].JAMA,2000,284(10):1256-62.