Graff Louis G, Wang Yun, Borkowski Brian, Tuozzo Kathy, Foody JoAnne M, Krumholz Harlan M, Radford Martha J
Qualidigm, Middletown, CT.
Acad Emerg Med. 2006 Sep;13(9):931-8. doi: 10.1197/j.aem.2006.04.016. Epub 2006 Aug 7.
Delay in diagnosis of acute myocardial infarction (AMI) may affect quality of care and its assessment.
To examine over time the frequency of delay in AMI diagnosis and the effect of this delay on the quality of patient care and its assessment.
The authors examined the trend in coded admission diagnosis, age, comorbidities, procedures during hospitalization, and discharge status for 42,406 Connecticut Medicare cases with the principal discharge diagnosis of AMI for the time period 1992 through 2001. For 2,583 cases discharged in 1992 and 1993 and for 1,398 cases discharged in 1998 through 2001, the rates of administration of aspirin (ASA) and beta blocker (BB) on admission and discharge, by admission diagnosis, were ascertained.
For patients discharged with the principal diagnosis of AMI over the decade examined, the proportion with this diagnosis on admission fell (59% to 40%, p < 0.001), the proportion with a non-acute coronary syndrome (ACS) admission diagnosis rose (18% to 26%, p < 0.001), and the population aged (proportion older than 85 years of age increased from 16% to 28%, p < 0.001). Patients with ACS as the admission diagnosis more frequently received cardiac catheterization (during 2000-2001, 39% versus 17%, p < 0.001), percutaneous coronary intervention (19% versus 4%, p < 0.001), and evidence-based therapy; during 1998-2001, opportunities to give ASA or BB on admission were fulfilled for 88% versus 73% (p < 0.001), and on discharge, for 87% versus 74% (p < 0.005).
The diagnosis of AMI is delayed after admission for a significant proportion of cases who receive care that is measured to be of lower quality. There is a need to more effectively diagnose and treat these cases with delayed diagnosis and to develop new quality measures to address changes in the characteristics of patients who are hospitalized with AMI.
急性心肌梗死（AMI）诊断延迟可能会影响医疗质量及其评估。
长期研究AMI诊断延迟的频率，以及这种延迟对患者医疗质量及其评估的影响。
作者研究了1992年至2001年期间，以AMI作为主要出院诊断的42406例康涅狄格州医疗保险病例的编码入院诊断、年龄、合并症、住院期间的治疗程序及出院状态的变化趋势。对于1992年和1993年出院的2583例病例以及1998年至2001年出院的1398例病例，确定了入院和出院时按入院诊断使用阿司匹林（ASA）和β受体阻滞剂（BB）的比例。
在研究的十年中，以AMI作为主要诊断出院的患者中，入院时诊断为此病的比例下降（59%降至40%，p<0.001），入院诊断为非急性冠状动脉综合征（ACS）的比例上升（18%升至26%，p<0.001），且老年人口比例（85岁以上的比例从16%增至28%，p<0.001）增加。以ACS作为入院诊断的患者更常接受心脏导管插入术（2000 - 2001年期间，39%对17%，p<0.001）、经皮冠状动脉介入治疗（19%对4%，p<0.001）以及循证治疗；在1998 - 2001年期间，入院时给予ASA或BB的机会实现率为88%对73%（p<0.001），出院时为87%对74%（p<0.005）。
对于很大一部分接受质量较低治疗的病例，AMI诊断在入院后被延迟。有必要更有效地诊断和治疗这些诊断延迟的病例，并制定新的质量指标以应对AMI住院患者特征的变化。
