Department of Psychiatry, University of Michigan, Commonwealth Blvd, Ann Arbor, MI, USA.
BMC Health Serv Res. 2010 Feb 19;10:44. doi: 10.1186/1472-6963-10-44.
Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. Stroke patients treated with tissue plasminogen activator (tPA) provide a particularly homogenous population for comparison because of strict eligibility criteria for treatment. We tested whether resource utilization would be similar in this homogenous population between two hospitals located in a single Midwestern US community by comparing use of diagnostic testing and associated outcomes following treatment with t-PA.
Medical records from 206 consecutive intravenous t-PA-treated stroke patients from two teaching hospitals (one university, one community-based) were reviewed. Patient demographics, clinical characteristics and outcome were analyzed, as were the frequency of use of CT, MRI, MRA, echocardiography, angiography, and EEG.
Seventy-nine and 127 stroke patients received t-PA at the university and community hospitals, respectively. The two patient populations were demographically similar. There were no differences in stroke severity. All outcomes were similar at both hospitals. Utilization of CT scans, and non-invasive carotid and cardiac imaging studies were similar at both hospitals; however, brain MR, TEE, and catheter angiography were used more frequently at the university hospital. EEG was obtained more often at the community hospital.
Utilization of advanced brain imaging and invasive diagnostic testing was greater at the university hospital, but was not associated with improved clinical outcomes. This could not be explained on the basis of stroke severity or patient characteristics. This variation of practice suggests substantial opportunities exist to reduce costs and improve efficiency of diagnostic resource use as well as reduce patient exposure to risk from diagnostic procedures.
医院间资源利用模式的比较通常因社区和患者人群的偏倚而变得复杂。接受组织型纤溶酶原激活剂（tPA）治疗的中风患者为比较提供了一个特别同质的人群，因为治疗的严格资格标准。我们通过比较在位于美国中西部一个单一社区的两家医院接受 t-PA 治疗的患者的诊断测试和相关结果的使用情况，来测试在这个同质人群中资源利用是否相似。
回顾了来自两家教学医院（一家大学医院，一家社区医院）的 206 例连续接受静脉注射 t-PA 治疗的中风患者的病历。分析了患者的人口统计学特征、临床特征和结果，以及 CT、MRI、MRA、超声心动图、血管造影和脑电图的使用频率。
79 名和 127 名中风患者分别在大学医院和社区医院接受 t-PA 治疗。这两个患者群体在人口统计学上相似。中风严重程度无差异。两家医院的所有结果均相似。两家医院的 CT 扫描以及非侵入性颈动脉和心脏成像研究的使用率相似；然而，在大学医院更频繁地使用脑部 MRI、TEE 和导管血管造影。在社区医院更经常获得 EEG。
在大学医院，高级脑部成像和有创性诊断测试的使用率更高，但与改善临床结果无关。这不能根据中风严重程度或患者特征来解释。这种实践的差异表明，在诊断资源的使用方面存在很大的机会，可以降低成本，提高效率，并减少患者暴露于诊断程序的风险。
