Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue – G250, Toronto, Ontario, Canada.
Int J Qual Health Care. 2012 Aug;24(4):425-32. doi: 10.1093/intqhc/mzs022. Epub 2012 May 16.
To evaluate whether the use of standard admission orders for patients admitted with acute myocardial infarction (AMI) is associated with better hospital quality of care.
Secondary analysis of a population-based database derived from a large cluster randomized AMI quality improvement trial.
Seventy-eight acute care hospital corporations located in Ontario, Canada.
A total of 5338 patients with AMI admitted directly to the coronary care/intensive care units of participating hospitals in 2004/2005. Main outcome measure(s) Hospital performance on seven process-of-care measures and a combined composite process-of-care measure. Secondary outcomes were 30-day and 1-year mortality rates.
Most patients (81%) were treated with standard admission orders. These patients were more likely to receive four of seven identified process-of-care measures (P< 0.05), including fibrinolytics ≤ 30 min or primary percutaneous coronary intervention ≤ 90 min of arrival, fibrinolytics administration decided by emergency department physician, aspirin ≤ 6 h of arrival and lipid test ≤ 24 h. After propensity-score matching (for risk adjustment), use of standard admission orders was not associated with significantly lower 30-day or 1-year mortality. However, patients who met the composite process-of-care measure had lower 30-day and 1-year mortality (relative risk= 0.51 (95% confidence interval (CI): 0.40-0.67) and 0.70 (95% CI: 0.58-0.84), respectively).
In AMI, the use of standard admission orders was associated with improved hospital performance on several but not all acute process-of-care quality indicators. The utilization of standard admission orders should be considered as a strategy for improving hospital care in patients admitted with AMI.
评估对急性心肌梗死（AMI）患者采用标准入院医嘱是否与更好的医院护理质量相关。
基于一项大型聚类随机 AMI 质量改进试验的人群数据库的二次分析。
加拿大安大略省的 78 家急性护理医院公司。
2004/2005 年共有 5338 名 AMI 患者直接入住参与医院的冠心病监护/重症监护病房。
七项护理过程指标和一项综合护理过程指标的医院绩效。次要结果是 30 天和 1 年死亡率。
大多数患者（81%）接受了标准入院医嘱治疗。这些患者更有可能接受七项确定的护理过程措施中的四项（P<0.05），包括纤溶酶≤30 min 或直接经皮冠状动脉介入≤90 min 到达、急诊科医生决定使用纤溶酶、阿司匹林≤6 h 到达和血脂检查≤24 h。经过倾向评分匹配（风险调整）后，使用标准入院医嘱与 30 天或 1 年死亡率的显著降低无关。然而，符合综合护理过程措施的患者 30 天和 1 年死亡率较低（相对风险=0.51（95%置信区间：0.40-0.67）和 0.70（95%置信区间：0.58-0.84））。
在 AMI 中，使用标准入院医嘱与改善几项但非所有急性护理质量指标相关。在 AMI 患者入院时，应考虑使用标准入院医嘱作为改善医院护理的策略。
