CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
JACC Heart Fail. 2013 Oct;1(5):445-53. doi: 10.1016/j.jchf.2013.07.001. Epub 2013 Sep 11.
This study sought to examine the associations of hospitalist and cardiologist care of patients with heart failure with outcomes and adherence to quality measures.
The hospitalist model of inpatient care has grown nationally, but its associations with quality of care and outcomes of patients hospitalized with heart failure are not known.
We analyzed data from the Get With the Guidelines-Heart Failure registry linked to Medicare claims for 2005 through 2008. For each hospital, we calculated the percentage of heart failure hospitalizations for which a hospitalist was the attending physician. We examined outcomes and care quality for patients stratified by rates of hospitalist use. Using multivariable models, we estimated associations between hospital-level use of hospitalists and cardiologists and 30-day risk-adjusted outcomes and adherence to measures of quality care.
The analysis included 31,505 Medicare beneficiaries in 166 hospitals. Across hospitals, the use of hospitalists varied from 0% to 83%. After multivariable adjustment, a 10% increase in the use of hospitalists was associated with a slight increase in mortality (risk ratio: 1.03; 95% confidence interval [CI]: 1.00 to 1.06) and decrease in length of stay (0.09 days; 95% CI: 0.02 to 0.16). There was no association with 30-day readmission. Increased use of hospitalists in hospitals with high use of cardiologists was associated with improved defect-free adherence to a composite of heart failure performance measures (risk ratio: 1.03; 95% CI: 1.01 to 1.06).
Hospitalist care varied significantly across hospitals for heart failure admissions and was not associated with improved 30-day outcomes. Comanagement by hospitalists and cardiologists may help to improve adherence to some quality measures, but it remains unclear what care model improves 30-day clinical outcomes.
本研究旨在探讨心力衰竭患者的医院医生和心脏病医生的治疗与结局和对质量措施的依从性的相关性。
住院医师模式的住院治疗在全国范围内得到了发展，但它与心力衰竭住院患者的治疗质量和结局的关系尚不清楚。
我们分析了 2005 年至 2008 年 Get With the Guidelines-Heart Failure 登记处与 Medicare 索赔相关的数据。对于每家医院，我们计算了医院医生担任主治医生的心力衰竭住院患者的百分比。我们根据医院医生使用率对患者进行分层，检查了结局和护理质量。使用多变量模型，我们估计了医院层面使用医院医生和心脏病医生与 30 天风险调整结局和对护理质量措施的依从性之间的关联。
该分析包括 166 家医院的 31505 名 Medicare 受益人。在医院之间，医院医生的使用率从 0%到 83%不等。在多变量调整后，医院医生使用率增加 10%与死亡率略有增加相关（风险比：1.03；95%置信区间[CI]：1.00 至 1.06）和住院时间缩短（0.09 天；95%CI：0.02 至 0.16）。与 30 天再入院无关联。在心脏病医生使用率高的医院中，医院医生使用率增加与心力衰竭绩效措施综合指标的无缺陷依从性提高相关（风险比：1.03；95%CI：1.01 至 1.06）。
心力衰竭入院的医院医生治疗在医院之间差异显著，与 30 天结局的改善无关。医院医生和心脏病医生的共同管理可能有助于提高一些质量措施的依从性，但尚不清楚哪种护理模式能改善 30 天的临床结局。
