Ahmed Ali, Weaver Michael T, Allman Richard M, DeLong James F, Aronow Wilbert S
Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama, Birmingham, AL, USA.
J Am Geriatr Soc. 2002 Nov;50(11):1831-6. doi: 10.1046/j.1532-5415.2002.50512.x.
To determine whether the quality of heart failure (HF) care of hospitalized nursing home (NH) residents is different from that of patients admitted from other locations.
Retrospective chart review.
Nursing home residents discharged from hospitals.
Medicare beneficiaries aged 65 and older.
Subjects were discharged with a primary discharge diagnosis of HF in Alabama in 1994. They were categorized as having been admitted from a NH or other locations. Bivariate logistic regression analysis was used to estimate crude odds ratios (ORs) and 95% confidence intervals (CIs) for left ventricular function (LVF) evaluation and angiotensin-converting enzyme (ACE) inhibitor use for NH residents relative to nonresidents. Multivariate generalized linear models were developed to determine independence of associations.
Subjects (N = 1,067 years) had a mean age +/- standard deviation of 79 +/- 7.4, 60% were female, and 18% were African Americans. Fewer NH residents (n = 95) received LVF evaluation (39% vs 60%, P <.001) and ACE inhibitors (50% vs 72%, P =.111). NH residents had lower odds for LVF evaluation (OR = 0.42, 95% CI = 0.27-0.64). The odds for ACE inhibitor use, although of similar magnitude, did not reach statistical significance (OR = 0.40, 95% CI = 0.12-1.28). After adjustment of patient and care characteristics, admission from a NH was significantly associated with lower LVF evaluation (adjusted OR = 0.64, 95% CI = 0.49-0.82) but not with ACE inhibitor use (adjusted OR = 0.59, 95% CI = 0.16-2.14).
Quality of HF care received by hospitalized NH residents was lower than that received by others. Further studies are needed to determine reasons for the lack of appropriate evaluation and treatment of NH patients with HF who are admitted to hospitals.
确定住院疗养院居民的心力衰竭（HF）护理质量是否与其他场所收治患者的护理质量不同。
回顾性病历审查。
从医院出院的疗养院居民。
65岁及以上的医疗保险受益人。
1994年在阿拉巴马州以HF作为主要出院诊断出院的受试者。他们被分类为从疗养院或其他场所入院。采用双变量逻辑回归分析来估计疗养院居民相对于非居民进行左心室功能（LVF）评估和使用血管紧张素转换酶（ACE）抑制剂的粗比值比（OR）和95%置信区间（CI）。建立多变量广义线性模型以确定关联的独立性。
受试者（N = 1067例）的平均年龄±标准差为79±7.4岁，60%为女性，18%为非裔美国人。接受LVF评估的疗养院居民较少（n = 95）（39%对60%，P <.001），使用ACE抑制剂的情况也是如此（50%对72%，P =.111）。疗养院居民进行LVF评估的几率较低（OR = 0.42，95%CI = 0.27 - 0.64）。使用ACE抑制剂的几率虽然幅度相似，但未达到统计学意义（OR = 0.40，95%CI = 0.12 - 1.28）。在调整患者和护理特征后，从疗养院入院与较低的LVF评估显著相关（调整后OR = 0.64，95%CI = 0.49 - 0.82），但与使用ACE抑制剂无关（调整后OR = 0.59，95%CI = 0.16 - 2.14）。
住院疗养院居民接受的HF护理质量低于其他人。需要进一步研究以确定入住医院的HF疗养院患者缺乏适当评估和治疗的原因。
