Qureshi Adnan I, Suri M Fareed K, Nasar Abu, Kirmani Jawad F, Ezzeddine Mustapha A, Divani Afshin A, Giles Wayne H
Stroke. 2007 Jul;38(7):2180-4. doi: 10.1161/STROKEAHA.106.467506. Epub 2007 May 24.
The purpose of this study was to evaluate the impact of new treatments by examining the changes between 1990 to 1991 and 2000 to 2001 in in-hospital mortality rates and hospital charges in adult patients with stroke.
From the Nationwide Inpatient Survey, the largest all-payer inpatient care database in the United States, patients with stroke admitted in 1990 to 1991 or 2000 to 2001 were studied. We analyzed hospital charges (adjusted for inflation based on the Consumer Price Index of the Bureau of Labor Statistics) and patient outcomes by type of institution: rural, urban nonteaching, and urban teaching in 1990 to 1991 and in 2000 to 2001.
In 1990 to 1991, there were 1 736 352 admissions for cerebrovascular diseases, and in 2000 to 2001, there were 1 958 018 admissions. The number of admissions in urban teaching hospitals increased by 13%, 19%, and 25%, for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall in-hospital mortality rate relatively declined by 36% for ischemic stroke, by 6% for intracerebral hemorrhages, and by 10% for subarachnoid hemorrhage. The mean hospital charges increased from $10 500 to $16 200 for patients with ischemic stroke, from $18 300 to $28 800 for patients with intracerebral hemorrhage, and from $37 400 to $65 900 for patients with subarachnoid hemorrhage. Mortality rates among patients admitted after ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were all lower in urban teaching hospitals than in rural and urban nonteaching hospitals and the mean charges per admission were all higher.
There has been an increase in the inflation-adjusted hospital charges for all patients with stroke and a reduction in mortality rates for all stroke subtypes probably related to an increase in the proportion of patients with stroke admitted to urban teaching hospitals.
本研究旨在通过考察1990至1991年与2000至2001年成年卒中患者的住院死亡率及住院费用的变化，评估新治疗方法的影响。
利用美国最大的全付费者住院护理数据库——全国住院病人调查，对1990至1991年或2000至2001年收治的卒中患者进行研究。我们按机构类型（农村、城市非教学医院和城市教学医院）分析了1990至1991年及2000至2001年的住院费用（根据劳工统计局消费者价格指数进行通胀调整）及患者转归。
1990至1991年，脑血管疾病住院患者有1736352例，2000至2001年有1958018例。城市教学医院缺血性卒中、脑出血和蛛网膜下腔出血的住院例数分别增加了13%、19%和25%。缺血性卒中的总体住院死亡率相对下降了36%，脑出血下降了6%，蛛网膜下腔出血下降了10%。缺血性卒中患者的平均住院费用从10500美元增至16200美元，脑出血患者从18300美元增至28800美元，蛛网膜下腔出血患者从37400美元增至65900美元。缺血性卒中、脑出血和蛛网膜下腔出血后住院患者的死亡率在城市教学医院均低于农村和城市非教学医院，且每次住院的平均费用均更高。
所有卒中患者经通胀调整后的住院费用有所增加，所有卒中亚型的死亡率有所降低，这可能与城市教学医院收治的卒中患者比例增加有关。
