Westfall John M, Kiefe Catarina I, Weissman Norman W, Goudie Anthony, Centor Robert M, Williams O Dale, Allison Jeroan J
University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA.
BMC Cardiovasc Disord. 2008 Sep 9;8:22. doi: 10.1186/1471-2261-8-22.
Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals.
National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy.
Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital.
Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.
许多急性心肌梗死（AMI）患者在住院期间会从一家医院转至另一家医院。关于院间转运相关结局的信息较少。本研究的目的是比较院间转运患者的急性心肌梗死护理过程和结局，特别关注对农村医院死亡率的影响。
合作心血管研究中医疗保险患者的全国样本（n = 184,295）。对急性心肌梗死住院病例进行回顾性结构化病历审查。采用描述性研究，对1994年2月至1995年7月间因临床确诊急性心肌梗死入住4765家医院的184,295例医疗保险患者的临床和管理数据进行回顾性倾向评分分析。主要结局指标包括：30天死亡率、阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和溶栓治疗的使用情况。
总体而言，51,530例（28%）患者接受了院间转运。转运患者比未转运患者明显更年轻、病情较轻且合并症较少。倾向匹配后，院间转运患者的护理质量更好，死亡率低于未转运患者。在农村医院接受治疗的患者与在城市医院接受治疗的患者死亡率相似。
转运患者与未转运患者有很大不同。然而，即使经过严格的倾向评分分析，转运患者的死亡率仍低于未转运患者。农村和城市医院的死亡率相似。识别从转运中获益最大的患者可能有助于医生面对是否转运急性心肌梗死患者这一复杂决策。
