Jin Yan, Quan Hude, Cujec Bibiana, Johnson David
Research and Evidence, Alberta Health and Wellness, Alberta, Canada.
J Card Fail. 2003 Aug;9(4):278-85. doi: 10.1054/jcaf.2003.43.
We compare the hospitalization rate, duration, cost, and mortality for newly diagnosed congestive heart failure in patients admitted to rural and metropolitan hospitals in one Canadian province.
Administrative data for Alberta, Canada, from April 1, 1994, to March 31, 2000.
Hospitalizations (16,162) for newly diagnosed congestive heart failure constituted 50% of all hospitalizations for congestive heart failure. Hospitals were distributed as follows: rural with less than 200 cases (21% of hospitalizations), rural with 204 to 646 cases (21% of hospitalizations), regional (13% of hospitalizations), metropolitan with angiography capability (24% of hospitalizations), and metropolitan without angiography capability (21% of hospitalizations). The hospitalization rate per 1000 population was lower for residents of metropolitan regions (1.01; 95% confidence interval [CI] 0.97 to 1.05) compared with residents of rural (1.70; 95% CI 1.65 to 1.75) and regional (1.95; 95% CI 1.90 to 2.00) health regions. Patient comorbidity and severity scores were lower in rural hospitals. Special care unit admissions and cardiac catheterizations were more frequent in patients admitted to metropolitan hospitals. After adjustment, the length of stay and mortality were similar amongst all hospital types. Adjusted hospital total costs were about 23% (900 Canadian dollars) greater in metropolitan hospitals with angiography capability compared to rural hospitals.
Hospital admission rates for newly diagnosed congestive heart failure were lower for metropolitan residents compared to non-metropolitan residents. Cost per admission was greatest in metropolitan hospitals with angiography capability compared to other hospital types.
我们比较了加拿大一个省份农村和大城市医院中，新诊断为充血性心力衰竭患者的住院率、住院时长、费用和死亡率。
采用加拿大艾伯塔省1994年4月1日至2000年3月31日的管理数据。
新诊断为充血性心力衰竭的住院病例（16,162例）占充血性心力衰竭所有住院病例的50%。医院分布如下：病例数少于200例的农村医院（占住院病例的21%），病例数为204至646例的农村医院（占住院病例的21%），地区医院（占住院病例的13%），具备血管造影能力的大城市医院（占住院病例的24%），以及不具备血管造影能力的大城市医院（占住院病例的21%）。大城市地区居民每1000人口的住院率（1.01；95%置信区间[CI] 0.97至1.05）低于农村（1.70；95% CI 1.65至1.75）和地区（1.95；95% CI 1.90至2.00）卫生区域的居民。农村医院患者的合并症和严重程度评分较低。大城市医院收治的患者入住特殊护理病房和进行心脏导管插入术的频率更高。调整后，所有医院类型的住院时长和死亡率相似。与农村医院相比，具备血管造影能力 的大城市医院调整后的住院总费用高出约23%（900加元）。
与非大城市居民相比，大城市居民新诊断为充血性心力衰竭的住院率较低。与其他医院类型相比，具备血管造影能力的大城市医院每次住院的费用最高。
