Department of Health Policy and Management Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
Med Care. 2010 Mar;48(3):273-8. doi: 10.1097/MLR.0b013e3181c161ba.
Process measures have been developed and implemented to evaluate the quality of care patients receive in the hospital. This study examines whether there is an association between the quality of in-hospital cardiac care and a hospital's proportion of low-income patients.
A retrospective analysis of 1979 hospitals submitting information on 12 quality of care (QoC) process measures for acute myocardial infarction (AMI) and congestive heart failure (CHF) patients to the Hospital Quality Alliance during 2005 and 2006 and meeting all study inclusion criteria. Mean hospital performance ranged from 84.2% (ACE inhibitor for left ventricular systolic dysfunction) to 95.9% (aspirin on arrival) for AMI QoC process measures and from 64.4% (discharge instructions) to 92.4% (left ventricular function assessment) for CHF QoC process measures. Regression analyses indicated a statistically significant negative association between the proportion of low-income patients and hospital performance for 10 of the 12 cardiac QoC process measures, after controlling for selected hospital characteristics.
Hospital adherence to QoC process measures for AMI and CHF patients declined as the proportion of low-income patients increased. Future research is needed to examine the role of community characteristics and market forces on the ability of hospitals with a disproportionate share of low-income patients to maintain the staffing, equipment, and policies necessary to provide the recommended standards of care for AMI and CHF patients.
已经制定并实施了流程措施，以评估患者在医院接受的护理质量。本研究检验了医院低收入患者比例与住院心脏护理质量之间是否存在关联。
对 2005 年至 2006 年期间向医院质量联盟提交 12 项急性心肌梗死（AMI）和充血性心力衰竭（CHF）患者护理质量（QoC）流程措施信息的 1979 家医院进行回顾性分析，且这些医院均符合所有研究纳入标准。医院的平均绩效范围从 AMI QoC 流程措施的 84.2%（左心室收缩功能障碍时使用 ACE 抑制剂）到 95.9%（到达时使用阿司匹林），以及 CHF QoC 流程措施的 64.4%（出院指导）到 92.4%（左心室功能评估）。回归分析表明，在控制了选定的医院特征后，低收入患者比例与 12 项心脏 QoC 流程措施中的 10 项之间存在统计学上显著的负相关。
随着低收入患者比例的增加，医院对 AMI 和 CHF 患者 QoC 流程措施的遵守程度下降。未来需要研究社区特征和市场力量对低收入患者比例过高的医院维持提供 AMI 和 CHF 患者推荐护理标准所需的人员配备、设备和政策的能力的影响。
