全科医生与心脏病专家之间的会诊与心力衰竭护理质量及结局的关联

Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care.

作者信息

Ahmed Ali, Allman Richard M, Kiefe Catarina I, Person Sharina D, Shaneyfelt Terrence M, Sims Richard V, Howard George, DeLong James F

机构信息

aDivision of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, Center for Aging, University of Alabama at Birmingham, USA.

出版信息

Am Heart J. 2003 Jun;145(6):1086-93. doi: 10.1016/S0002-8703(02)94778-2.

DOI:10.1016/S0002-8703(02)94778-2

PMID:12796767

Abstract

BACKGROUND

The appropriate roles for generalists and cardiologists in the care of patients with heart failure (HF) are unknown. The objective of this retrospective cohort study was to determine whether consultation between generalists and cardiologists was associated with better quality and outcomes of HF care.

METHODS

We studied left ventricular function evaluation (LVFE) and angiotensin-converting enzyme inhibitor (ACEI) use and 90-day readmission and 90-day mortality rates in patients with HF who were hospitalized. Patient care was categorized into cardiologist (solo), generalist (solo), or consultative cares. The processes and outcomes of care were compared by care category using logistic regression analyses fit with generalized linear mixed models to adjust for hospital-related clustering.

RESULTS

Of the 1075 patients studied, 13% received cardiologist care, 55% received generalist care, and 32% received consultative care. More patients who received consultative care (75%) received LVFE than patients who received generalist care (36%) and cardiologist care (53%; P <.001). Fewer patients who received solo care (54% each) received ACEI compared with 71% of patients who received consultative care (P <.001). After multivariable adjustment, consultative care was associated with higher odds of LVFE than generalist care (adjusted odds ratio [OR], 6.06; 95% CI, 3.97-9.26) or cardiologist care (adjusted OR, 2.96; 95% CI, 1.70-5.13) care. Consultation was also associated with higher odds of ACEI use compared with generalist (adjusted OR, 2.42; 95% CI, 1.42-4.12) or cardiologist (adjusted OR, 2.32; 95% CI, 1.14-4.72) care. Compared with patients who received generalist care, patients who received consultative care had lower odds of 90-day readmission (adjusted OR, 0.54; 95% CI, 0.34-0.86).

CONCLUSION

Collaboration between generalists and cardiologists, rather than solo care by either, was associated with better HF processes and outcomes of care.

摘要

背景

在心力衰竭（HF）患者的护理中，全科医生和心脏病专家的恰当角色尚不清楚。这项回顾性队列研究的目的是确定全科医生和心脏病专家之间的会诊是否与更好的HF护理质量和结局相关。

方法

我们研究了住院HF患者的左心室功能评估（LVFE）、血管紧张素转换酶抑制剂（ACEI）的使用情况以及90天再入院率和90天死亡率。患者护理被分为心脏病专家（单独护理）、全科医生（单独护理）或会诊护理。通过使用拟合广义线性混合模型的逻辑回归分析按护理类别比较护理过程和结局，以调整与医院相关的聚类情况。

结果

在研究的1075例患者中，13%接受心脏病专家护理，55%接受全科医生护理，32%接受会诊护理。接受会诊护理的患者（75%）进行LVFE的比例高于接受全科医生护理的患者（36%）和接受心脏病专家护理的患者（53%；P<.001）。与接受会诊护理的患者中71%相比，接受单独护理的患者（各54%）接受ACEI的比例较低（P<.001）。经过多变量调整后，会诊护理与进行LVFE的几率高于全科医生护理（调整后的优势比[OR]，6.06；95%CI，3.97 - 9.26）或心脏病专家护理（调整后的OR，2.96；95%CI，1.70 - 5.13）相关。与全科医生护理（调整后的OR，2.42；95%CI，1.42 - 4.12）或心脏病专家护理（调整后的OR，2.32；95%CI，1.14 - 4.72）相比，会诊也与使用ACEI的几率较高相关。与接受全科医生护理的患者相比，接受会诊护理的患者90天再入院几率较低（调整后的OR，0.54；95%CI，0.34 - 0.86）。