Variation in Hospital Mortality Rates for Patients With Acute Myocardial Infarction

被引：53

作者：

Bradley, Elizabeth H. ^{[1
,3
]}

Herrin, Jeph ^{[2
]}

Curry, Leslie ^{[1
,3
]}

Cherlin, Emily J. ^{[1
]}

Wang, Yongfei ^{[2
,4
]}

Webster, Tashonna R. ^{[1
]}

Drye, Elizabeth E. ^{[4
]}

Normand, Sharon-Lise T. ^{[5
,6
]}

Krumholz, Harlan M. ^{[1
,2
,3
,4
]}

机构：

[1] Yale Univ, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06520 USA

[2] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT USA

[3] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, Dept Med, New Haven, CT USA

[4] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA

[5] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA

[6] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2010年 / 106卷 / 08期

关键词：

QUALITY-OF-CARE; 30-DAY MORTALITY; ELDERLY-PATIENTS; OUTCOMES; ASSOCIATION; MODELS;

D O I：

10.1016/j.amjcard.2010.06.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Hospitals vary by twofold in their hospital-specific 30-day risk-stratified mortality rates (RSMRs) for Medicare beneficiaries with acute myocardial infarction (AMI). However, we lack a comprehensive investigation of hospital characteristics associated with 30-day RSMRs and the degree to which the variation in 30-day RSMRs is accounted for by these characteristics, including the socioeconomic status (SES) profile of hospital patient populations. We conducted a cross-sectional national study of hospitals with >= 15 AMI discharges from July 1, 2005 to June 20, 2008. We estimated a multivariable weighted regression using Medicare claims data for hospital-specific 30-day RSMRs, American Hospital Association Survey of Hospitals for hospital characteristics, and the United States Census data reported by Neilsen Claritas, Inc., for zip-code level estimates of SES status. Analysis included 2,908 hospitals with 513,202 AMI discharges. Mean hospital 30-day RSMR was 16.5% (SD 1.7 percentage points). Our multivariable model explained 17.1% of the variation in hospital-specific 30-day RSMRs. Teaching status, number of hospital beds, AMI volume, cardiac facilities available, urban/rural location, geographic region, ownership type, and SES profile of patients were significantly (p <0.05) associated with 30-day RSMRs. In conclusion, substantial variation in hospital outcomes for patients with AMI remains unexplained by measurements of hospital characteristics including SES patient profile. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:1108-1112)

引用

页码：1108 / 1112

页数：5

共 19 条

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