Gandjour A, Kleinschmit F, Lauterbach K W
Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
Eur Heart J. 2002 Jun;23(11):858-68. doi: 10.1053/euhj.2001.3080.
To compare the inpatient costs and process quality in the treatment of acute myocardial infarction in France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the U.K.
A total of 208 European hospitals assessed services for one hypothetical average patient with acute myocardial infarction (cost evaluation) and prospectively followed up one or two real acute myocardial infarction patients (quality evaluation) in 2000/2001. The following cost modules were evaluated: general medicine ward, critical care unit (both personnel costs only), and reperfusion therapy. The following process quality indicators were evaluated: reperfusion therapy; and prescription of aspirin, lidocaine, beta-blockers, and ACE inhibitors.
Switzerland, Germany, and France had the highest reperfusion costs due to a relatively high percentage of patients receiving percutaneous transluminal coronary angioplasties, stents, and glycoprotein IIb/IIIa blockers. Personnel costs for general medicine wards and critical care units were highest in Italy and Germany due to relatively long hospital stays. Average quality ratings ranged from 89% in the U.K. and France to 96% in Germany.
There was little variation in the process quality of care for treating acute myocardial infarction. Differences in resource use may result from differences in the types of reimbursement and in the rates of diffusion of new technology.
比较法国、德国、意大利、荷兰、瑞典、瑞士和英国治疗急性心肌梗死的住院费用和医疗过程质量。
2000/2001年，共有208家欧洲医院对一名假设的急性心肌梗死普通患者的服务进行了评估（成本评估），并对一两名实际的急性心肌梗死患者进行了前瞻性随访（质量评估）。评估了以下成本模块：普通内科病房、重症监护病房（仅人员成本）和再灌注治疗。评估了以下医疗过程质量指标：再灌注治疗；以及阿司匹林、利多卡因、β受体阻滞剂和血管紧张素转换酶抑制剂的处方。
瑞士、德国和法国的再灌注成本最高，原因是接受经皮冠状动脉腔内血管成形术、支架和糖蛋白IIb/IIIa阻滞剂治疗的患者比例相对较高。由于住院时间相对较长，意大利和德国普通内科病房和重症监护病房的人员成本最高。平均质量评分从英国和法国的89%到德国的96%不等。
治疗急性心肌梗死的医疗过程质量差异不大。资源使用的差异可能源于报销类型的差异和新技术的推广速度。
