急性心肌梗死患者的医院绩效综合评估及相关死亡率。国家心血管结果研究机构（NICOR）对个别医院绩效和结果的分析。
An assessment of composite measures of hospital performance and associated mortality for patients with acute myocardial infarction. Analysis of individual hospital performance and outcome for the National Institute for Cardiovascular Outcomes Research (NICOR).
机构信息
University of Leeds, Leeds, UK ; University of York, York, UK ; York Teaching Hospital NHS Foundation Trust, York, UK.
出版信息
Eur Heart J Acute Cardiovasc Care. 2013 Mar;2(1):9-18. doi: 10.1177/2048872612469132.
AIM
To investigate whether a hospital-specific opportunity-based composite score (OBCS) was associated with mortality in 136,392 patients with acute myocardial infarction (AMI) using data from the Myocardial Ischaemia National Audit Project (MINAP) 2008-2009.
METHODS AND RESULTS
For 199 hospitals a multidimensional hospital OBCS was calculated on the number of times that aspirin, thienopyridine, angiotensin-converting enzyme inhibitor (ACEi), statin, β-blocker, and referral for cardiac rehabilitation was given to individual patients, divided by the overall number of opportunities that hospitals had to give that care. OBCS and its six components were compared using funnel plots. Associations between OBCS performance and 30-day and 6-month all-cause mortality were quantified using mixed-effects regression analysis. Median hospital OBCS was 95.3% (range 75.8-100%). By OBCS, 24.1% of hospitals were below funnel plot 99.8% CI, compared to aspirin (11.1%), thienopyridine (15.1%), β-blockers (14.7%), ACEi (19.1%), statins (12.1%), and cardiac rehabilitation (17.6%) on discharge. Mortality (95% CI) decreased with increasing hospital OBCS quartile at 30 days [Q1, 2.25% (2.07-2.43%) vs. Q4, 1.40% (1.25-1.56%)] and 6 months [Q1, 7.93% (7.61-8.25%) vs. Q4, 5.53% (5.22-5.83%)]. Hospital OBCS quartile was inversely associated with adjusted 30-day and 6-month mortality [OR (95% CI), 0.87 (0.80-0.94) and 0.92 (0.88-0.96), respectively] and persisted after adjustment for coronary artery catheterization [0.89 (0.82-0.96) and 0.95 (0.91-0.98), respectively].
CONCLUSIONS
Multidimensional hospital OBCS in AMI survivors are high, discriminate hospital performance more readily than single performance indicators, and significantly inversely predict early and longer-term mortality.
目的
利用 2008-2009 年心肌血运重建国家审计项目（MINAP）的数据，调查医院特定的基于机会的综合评分（OBCS）是否与 136392 例急性心肌梗死（AMI）患者的死亡率相关。
方法和结果
对 199 家医院进行了多维医院 OBCS 计算，即根据患者接受阿司匹林、噻吩吡啶、血管紧张素转换酶抑制剂（ACEi）、他汀类药物、β受体阻滞剂和心脏康复转诊的次数，除以医院给予该护理的总机会次数。使用漏斗图比较 OBCS 和其六个组成部分。使用混合效应回归分析定量评估 OBCS 表现与 30 天和 6 个月全因死亡率之间的关联。医院 OBCS 的中位数为 95.3%（范围 75.8-100%）。根据 OBCS，与阿司匹林（11.1%）、噻吩吡啶（15.1%）、β受体阻滞剂（14.7%）、ACEi（19.1%）、他汀类药物（12.1%）和心脏康复（17.6%）相比，24.1%的医院处于漏斗图 99.8%CI 以下。30 天[Q1，2.25%（2.07-2.43%）与 Q4，1.40%（1.25-1.56%）]和 6 个月[Q1，7.93%（7.61-8.25%）与 Q4，5.53%（5.22-5.83%）]的死亡率（95%CI）随医院 OBCS 四分位距的增加而降低。医院 OBCS 四分位距与调整后的 30 天和 6 个月死亡率呈负相关[OR（95%CI），0.87（0.80-0.94）和 0.92（0.88-0.96）]，并且在调整冠状动脉导管插入术后仍然存在[0.89（0.82-0.96）和 0.95（0.91-0.98）]。
结论
AMI 幸存者的多维医院 OBCS 较高，比单一绩效指标更能区分医院绩效，并且显著反向预测早期和长期死亡率。
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