Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, Mail Stop 152, Iowa City, IA, USA.
Health Serv Res. 2010 Feb;45(1):62-78. doi: 10.1111/j.1475-6773.2009.01066.x. Epub 2009 Dec 4.
Compare characteristics and outcomes of patients hospitalized in specialty cardiac and general hospitals for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG).
2000-2005 all-payor administrative data from Arizona, California, Texas, and Wisconsin.
We identified patients admitted to specialty and competing general hospitals with AMI or CABG and compared patient demographics, comorbidity, and risk-standardized mortality in specialty and general hospitals.
Specialty hospitals admitted a lower proportion of women and blacks and treated patients with less comorbid illness than general hospitals. Unadjusted in-hospital AMI mortality for Medicare enrollees in specialty and general hospitals was 6.1 and 10.1 percent (p<.0001) and for non-Medicare enrollees was 2.8 and 4.0 percent (p<.04). Unadjusted in-hospital CABG mortality for Medicare enrollees in specialty and general hospitals was 3.2 and 4.7 percent (p<.01) and for non-Medicare enrollees was 1.1 and 1.8 percent (p=.02). After adjusting for patient characteristics and hospital volume, risk-standardized in-hospital mortality for all AMI patients was 2.7 percent for specialty hospitals and 4.1 percent for general hospitals (p<.001) and for CABG was 1.5 percent for specialty hospitals and 2.0 percent for general hospitals (p=.07).
In-hospital mortality in specialty hospitals was lower than in general hospitals for AMI but similar for CABG. Our results suggest that specialty hospitals may offer significantly better outcomes for AMI but not CABG.
比较因急性心肌梗死（AMI）和冠状动脉旁路移植术（CABG）住院的专科心脏医院和综合医院患者的特征和结局。
来自亚利桑那州、加利福尼亚州、得克萨斯州和威斯康星州的 2000-2005 年全付费管理数据。
我们确定了因 AMI 或 CABG 入住专科和竞争综合医院的患者，并比较了专科和综合医院患者的人口统计学特征、合并症和风险标准化死亡率。
专科医院收治的女性和黑人比例较低，合并症较少。专科和综合医院 Medicare 参保患者的未调整院内 AMI 死亡率分别为 6.1%和 10.1%（p<.0001），非 Medicare 参保患者分别为 2.8%和 4.0%（p<.04）。专科和综合医院 Medicare 参保患者的未调整院内 CABG 死亡率分别为 3.2%和 4.7%（p<.01），非 Medicare 参保患者分别为 1.1%和 1.8%（p=.02）。在调整患者特征和医院容量后，所有 AMI 患者的风险标准化院内死亡率为专科医院 2.7%，综合医院 4.1%（p<.001），CABG 为专科医院 1.5%，综合医院 2.0%（p=.07）。
专科医院的 AMI 院内死亡率低于综合医院，但 CABG 院内死亡率相似。我们的研究结果表明，专科医院可能为 AMI 患者提供显著更好的结局，但对 CABG 患者则不然。
