Academic Unit of Primary Health Care, University of Bristol, 25-27 Belgrave Road, Bristol BS8 2AA, UK.
Academic Unit of Primary Health Care, University of Bristol, 25-27 Belgrave Road, Bristol BS8 2AA, UK.
Public Health. 2011 Jan;125(1):46-54. doi: 10.1016/j.puhe.2010.07.006. Epub 2010 Dec 23.
Coronary heart disease (CHD) is a common reason for emergency admission in England. The objective of this study was to determine the association between general practice, population and hospital characteristics, including quality and outcomes framework (QOF) scores, with emergency admissions for angina, which is an ambulatory-care-sensitive condition, and myocardial infarction (MI).
Cross-sectional study using hospital episode statistics, population and primary care data.
Pooled admissions (2005/2006) for all general practices in England adjusted for age and gender. Main outcome measures were relative rates of admission [incidence rate ratio (IRR)] for general practices adjusted for confounding variables in a multiple regression Poisson model.
There were 80,377 admissions for angina and 62,373 admissions for MI for individuals aged ≥45 years. Characteristics positively associated with admission were deprivation [angina IRR 1.084 (95% confidence interval 1.052-1.117) per quartile increase, MI IRR 1.018 (95% confidence interval 1.009-1.028)], practice prevalence of CHD and smoking. Living in an urban area and closer to the emergency department increased the risk of admission for angina. Higher overall clinical QOF score was negatively associated with the risk of admission for angina. Training practices and higher numbers of general practitioners per registered population were associated with lower rates of MI admission. Practice size and condition-specific quality markers for CHD were not associated with the risk of admission.
There is no clinically significant relationship between better quality of primary care, as measured by disease-specific QOF measures, and fewer CHD admissions. Deprivation, CHD prevalence and smoking are major risk factors for emergency admission for CHD.
冠心病（CHD）是英国急诊入院的常见原因。本研究旨在确定一般实践、人口和医院特征（包括质量和结果框架（QOF）评分）与心绞痛（一种门诊护理敏感病症）和心肌梗死（MI）的急诊入院之间的关联。
使用医院发病统计数据、人口和初级保健数据进行的横断面研究。
调整年龄和性别后，对英格兰所有普通诊所的住院患者进行了汇总。主要观察指标是在多回归泊松模型中，对混杂变量进行调整后的一般实践住院率[发病率比（IRR）]。
≥45 岁的个体中，有 80377 例心绞痛住院和 62373 例心肌梗死住院。与住院相关的特征是贫困[心绞痛 IRR 1.084（95%置信区间 1.052-1.117）每增加一个四分位数，MI IRR 1.018（95%置信区间 1.009-1.028）]、CHD 流行和吸烟。居住在城市地区和靠近急诊部会增加心绞痛住院的风险。整体临床 QOF 评分较高与心绞痛住院风险呈负相关。培训实践和每注册人口中更多的全科医生与较低的 MI 住院率相关。实践规模和特定于 CHD 的质量标志物与入院风险无关。
以疾病特异性 QOF 措施衡量的初级保健质量提高与 CHD 入院减少之间没有临床显著关系。贫困、CHD 流行和吸烟是 CHD 急诊入院的主要危险因素。
