Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2011 Nov-Dec;27(6):731-8. doi: 10.1016/j.cjca.2011.08.114. Epub 2011 Oct 19.
In order to reduce the delays encountered through patient transfer, regional care models have been developed that directly transport subsets of acute myocardial infarction (AMI) patients to hospitals with percutaneous coronary intervention (PCI) facilities. Calgary is a Canadian city that implemented this type of model in 2004.
The study population included 9768 AMI patients admitted to Calgary hospitals between 1997 and 2007. Administrative data were used to define patients who were directly admitted to the PCI hospital and those transferred there after initial admission to a hospital without specialized cardiac care. The differences in clinical characteristics and mortality trends of patients grouped by hospital delivery site and transfer practice are described.
The proportion of patients directly admitted to a PCI hospital has increased with the implementation of a regional care model. Among patients admitted to non-PCI facilities, the patients who are transferred are younger, more likely to be male, have a shorter length of stay, and have lower proportions of several comorbid conditions. The risk-adjusted in-hospital mortality odds ratio for patients who received care at the PCI hospital postmodel relative to those treated at non-PCI hospitals premodel was 0.38 (95% confidence interval, 0.31-0.47). The corresponding adjusted odds ratio was 0.60 (0.47-0.76).
Our results suggest changing care over time and trends toward improved outcomes. Patients' clinical characteristics appear to play a major role in the decision to transfer. Avoidance of the risk treatment paradox through refinement of regional transfer protocols ought to be a priority.
为了减少患者转院带来的延误，已经开发出区域护理模式，直接将部分急性心肌梗死（AMI）患者转运至具备经皮冠状动脉介入治疗（PCI）设施的医院。加拿大卡尔加里市于 2004 年实施了这种模式。
研究人群包括 1997 年至 2007 年期间入住卡尔加里医院的 9768 例 AMI 患者。使用行政数据来确定直接收入 PCI 医院的患者和那些最初收入不具备心脏专科治疗能力的医院后被转入该医院的患者。描述了按医院入院地点和转院实践分组的患者的临床特征和死亡率趋势差异。
随着区域护理模式的实施，直接收入 PCI 医院的患者比例有所增加。在收入非 PCI 设施的患者中，转院患者年龄更小，更可能为男性，住院时间更短，且合并症比例较低。与模型实施前在非 PCI 医院接受治疗的患者相比，模型实施后在 PCI 医院接受治疗的患者住院期间的风险调整死亡率比值比为 0.38（95%置信区间，0.31-0.47）。相应的调整比值比为 0.60（0.47-0.76）。
我们的结果表明随着时间的推移，治疗方式发生了变化，并且结果呈改善趋势。患者的临床特征似乎在转院决策中起主要作用。通过完善区域转院协议，避免风险治疗悖论应成为当务之急。
