Polanczyk Carsi A, Lane Anthereca, Coburn Michelle, Philbin Edward F, Dec G William, DiSalvo Thomas G
Heart Failure and Cardiac Transplantation Unit, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Am J Med. 2002 Mar;112(4):255-61. doi: 10.1016/s0002-9343(01)01112-3.
The possible benefit that hospital teaching status may confer in the care of patients with cardiovascular disease is unknown. Our purpose was to determine the effect of hospital teaching status on in-hospital mortality, use of invasive procedures, length of stay, and charges in patients with myocardial infarction, heart failure, or stroke.
We analyzed a New York State hospital administrative database containing information on 388 964 consecutive patients who had been admitted with heart failure (n = 173 799), myocardial infarction (n = 121 209), or stroke (n = 93 956) from 1993 to 1995. We classified the 248 participating acute care hospitals by teaching status (major, minor, nonteaching). The primary outcomes were standardized in-hospital mortality ratios, defined as the ratio of observed to predicted mortality.
Standardized in-hospital mortality ratios were significantly lower in major teaching hospitals (0.976 for heart failure, 0.945 for myocardial infarction, 0.958 for stroke) than in nonteaching hospitals (1.01 for heart failure, 1.01 for myocardial infarction, 0.995 for stroke). Standardized in-hospital mortality ratios were significantly higher for patients with stroke (1.06) but not heart failure (1.0) or myocardial infarction (1.06) in minor teaching hospitals than in nonteaching hospitals. Compared with nonteaching hospitals, use of invasive cardiac procedures and adjusted hospital charges were significantly greater in major and minor teaching hospitals for all three conditions. The adjusted length of stay was also shorter for myocardial infarction in major teaching hospitals and longer for stroke in minor teaching hospitals.
Major teaching hospital status was an important determinant of outcomes in patients hospitalized with myocardial infarction, heart failure, or stroke in New York State.
医院教学地位在心血管疾病患者护理中可能带来的益处尚不清楚。我们的目的是确定医院教学地位对心肌梗死、心力衰竭或中风患者的院内死亡率、侵入性操作的使用、住院时间和费用的影响。
我们分析了纽约州医院管理数据库，该数据库包含1993年至1995年期间连续收治的388964例心力衰竭（n = 173799）、心肌梗死（n = 121209）或中风（n = 93956）患者的信息。我们根据教学地位（主要、次要、非教学）对248家参与的急性护理医院进行了分类。主要结局是标准化院内死亡率，定义为观察到的死亡率与预测死亡率的比值。
主要教学医院的标准化院内死亡率（心力衰竭为0.976，心肌梗死为0.945，中风为0.958）显著低于非教学医院（心力衰竭为1.01，心肌梗死为1.01，中风为0.995）。次要教学医院中风患者（1.06）的标准化院内死亡率显著高于非教学医院，但心力衰竭（1.0）或心肌梗死（1.06）患者则不然。与非教学医院相比，在所有三种情况下，主要和次要教学医院侵入性心脏操作的使用和调整后的医院费用显著更高。主要教学医院心肌梗死患者的调整后住院时间也较短，次要教学医院中风患者的住院时间较长。
在纽约州，主要教学医院地位是心肌梗死、心力衰竭或中风住院患者结局的重要决定因素。
