Mathews Simon C, Kelen Gabor D, Pronovost Peter J, Pham Julius Cuong
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Med Qual. 2010 Nov-Dec;25(6):429-35. doi: 10.1177/1062860610369171. Epub 2010 Aug 17.
The objective of this study was to measure the relationship between emergency medicine (EM) specialty training and quality measures in the emergency department (ED). Data were gathered from the 2003-2004 National Hospital Ambulatory Medical Care Survey. The outcome was proportion of patients with acute myocardial infarction (AMI), pneumonia (PNA), and long-bone fracture (LBF) who received recommended therapy. These measures were analyzed with respect to EM residency completion. Compared with EDs with more than 80% EM-trained physicians, EDs with fewer than 80% EM-trained physicians had similar rates of aspirin (43% vs 42%) and β-blocker (26% vs 19%) use for AMI, appropriate antibiotics (78% vs 83%) and pulse oximetry (51% vs 55%) for PNA, and analgesia (85% vs 79%) for LBF. Additionally, a composite end point and an adjusted model showed no statistical difference across these measures. The proportion of residency-trained EM physicians did not affect the use of recommended treatment for AMI, PNA, and LBF.
本研究的目的是衡量急诊医学（EM）专科培训与急诊科（ED）质量指标之间的关系。数据收集自2003 - 2004年国家医院门诊医疗调查。结果指标是急性心肌梗死（AMI）、肺炎（PNA）和长骨骨折（LBF）患者接受推荐治疗的比例。这些指标根据急诊医学住院医师培训完成情况进行分析。与急诊医学培训医师比例超过80%的急诊科相比，急诊医学培训医师比例低于80%的急诊科在以下方面的使用率相似：AMI患者使用阿司匹林（43%对42%）和β受体阻滞剂（26%对19%）；PNA患者使用适当抗生素（78%对83%）和脉搏血氧饱和度测定（51%对55%）；LBF患者使用镇痛剂（85%对79%）。此外，综合终点和调整模型显示这些指标之间无统计学差异。接受住院医师培训的急诊医学医师比例不影响AMI、PNA和LBF推荐治疗的使用。
