WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
J Rural Health. 2010 Winter;26(1):51-7. doi: 10.1111/j.1748-0361.2009.00265.x.
In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted.
Using inpatient records data for 34,776 Medicare beneficiaries with AMI from 2000-2001, unadjusted and logistic regression analysis compared receipt of 5 recommended treatments between admissions to urban, large rural, small rural, and isolated small rural hospitals as defined by Rural Urban Commuting Area codes.
Substantial proportions of hospital admissions in all areas did not receive guideline-recommended treatments (eg, 17.0% to 23.6% without aspirin within 24 hours of admission, 30.8% to 46.6% without beta-blockers at arrival/discharge). Admissions to small rural and isolated small rural hospitals were least likely to receive most treatments (eg, 69.2% urban, 68.3% large rural, 59.9% small rural, 53.4% isolated small rural received discharge beta-blocker prescriptions). Adjusted analyses found no treatment differences between admissions to large rural and urban area hospitals, but admissions to small rural and isolated small rural hospitals had lower rates of discharge prescriptions such as aspirin and beta-blockers than urban hospital admissions.
Many simple guidelines that improve AMI outcomes are inadequately implemented, regardless of geographic location. In small rural and isolated small rural hospitals, addressing barriers to prescription of beneficial discharge medications is particularly important. The best quality improvement practices should be identified and translated to the broadest range of institutions and providers.
20 世纪 90 年代中期，农村和城市医院之间在急性心肌梗死（AMI）治疗质量方面存在显著差距。此后，整体 AMI 治疗质量有所提高。本研究使用最新数据来确定城乡 AMI 质量差距是否仍然存在。
利用 2000-2001 年 Medicare 受益人的住院记录数据，根据农村-城市通勤区代码，对 34776 名 AMI 患者的入院记录进行未经调整和逻辑回归分析，比较了在城市、大农村、小农村和孤立小农村医院就诊的患者接受 5 种推荐治疗方法的比例。
所有地区的住院患者接受指南推荐治疗的比例都很高（例如，入院 24 小时内未接受阿司匹林治疗的比例为 17.0%至 23.6%，入院/出院时未接受β受体阻滞剂治疗的比例为 30.8%至 46.6%）。小农村和孤立小农村医院的住院患者最不可能接受大多数治疗（例如，69.2%的城市、68.3%的大农村、59.9%的小农村、53.4%的孤立小农村接受出院β受体阻滞剂处方）。调整分析发现，大农村和城市地区医院的住院患者之间的治疗差异无统计学意义，但小农村和孤立小农村医院的出院阿司匹林和β受体阻滞剂等处方率低于城市医院的住院患者。
无论地理位置如何，许多改善 AMI 结果的简单指南都没有得到充分实施。在小农村和孤立小农村医院，解决开具有益出院药物的障碍尤为重要。应确定最佳的质量改进实践，并将其推广到最广泛的机构和提供者。
