住院受伤患者结局的地区差异。

Regional differences in outcomes for hospitalized injured patients.

作者信息

Mullins Richard J, Diggs Brian S, Hedges Jerris R, Newgard Craig D, Arthur Melanie, Adams Annette L, Veum-Stone Judith, Lenfesty Barbara, Trunkey Donald D

机构信息

Department of Surgery, Oregon Health and Science University, Portland, 97239, USA.

出版信息

J Trauma. 2006 Apr;60(4):691-8; discussion 699-700. doi: 10.1097/01.ta.0000210454.92078.89.

DOI:10.1097/01.ta.0000210454.92078.89

PMID:16612288

Abstract

BACKGROUND

Our goal was to use a hospital population-based data set that was a sample of all injured patients admitted to a hospital in the United States to develop universal measures of outcome and processes of care.

METHODS

Patients with a primary discharge diagnosis of injury (ICD-9 800 to 959) in the HCUP/Nationwide Inpatient Sample for the years 1995 to 2000 were used to estimate the annual number of hospitalized injured patients. Using census data, we calculated age- and sex- adjusted average annual incidence rates for four census regions in the United States: Northeast, Midwest, South and West. Outcomes measured were annual rates per million populations of hospitalization rate, death rate, and potentially ineffective care (PIC) rate defined as >28 days of hospitalization ending in death. Length of stay (LOS) was calculated as total number of days annually hospitalized for injury for census regions per million populations.

RESULTS

Incidence rates per million populations and 95% confidence intervals for rate of hospitalizations for injury were: Northeast, 5596 (5338-5853); Midwest, 5516 (5316-5716); South, 5639 (5410-5869); West, 5307 (5071-5543). Incidence rates per million populations and 95% confidence intervals for rate of in-hospital deaths were: Northeast, 129 (119-139); Midwest, 131 (122-139); South, 141 (129-152); West, 114 (106-123). Incidence rates per million populations and 95% confidence intervals for rate of PIC were: Northeast, 11 (10-13); Midwest, 5 (4-5); South, 6 (5-7); West, 4 (3-4). Incidence rates per million populations and 95% confidence intervals for hospital days were: Northeast, 34 (32-36); Midwest, 30 (28-31); South, 30 (29-32); West, 26 (24-27).

CONCLUSION

Regional differences in outcomes and processes of care for hospitalized injured patients exist and may be influenced by hospital characteristics and region of the country. Research to identify the factors that cause these hospital and regional variations is needed. These observations suggest that to develop a uniform standard for quality of care, it will be essential to have valid and robust hospital population-based measures.

摘要

背景

我们的目标是使用基于医院人群的数据集（该数据集是美国一家医院收治的所有受伤患者的样本）来制定通用的结局指标和护理流程指标。

方法

使用1995年至2000年HCUP/全国住院患者样本中主要出院诊断为损伤（国际疾病分类第九版800至959）的患者来估计每年住院受伤患者的数量。利用人口普查数据，我们计算了美国四个普查区域（东北部、中西部、南部和西部）按年龄和性别调整后的年均发病率。所测量的结局指标包括每百万人口的年住院率、死亡率以及定义为住院超过28天且最终死亡的潜在无效护理（PIC）率。住院时间（LOS）计算为每个普查区域每百万人口每年因损伤住院的总天数。

结果

每百万人口中损伤住院率及其95%置信区间为：东北部，5596（5338 - 5853）；中西部，5516（5316 - 5716）；南部，5639（5410 - 5869）；西部，5307（5071 - 5543）。每百万人口中院内死亡率及其95%置信区间为：东北部，129（119 - 139）；中西部，131（122 - 139）；南部，141（129 - 152）；西部，114（106 - 123）。每百万人口中PIC率及其95%置信区间为：东北部，11（10 - 13）；中西部，5（4 - 5）；南部，6（5 - 7）；西部，4（3 - 4）。每百万人口中住院天数及其95%置信区间为：东北部，34（32 - 36）；中西部，30（28 - 31）；南部，30（29 - 32）；西部，26（24 - 27）。