Bidmead Tom, Goodacre Steve, Maheswaran Ravi, O'Cathain Alicia
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Emerg Med J. 2015 Jun;32(6):439-43. doi: 10.1136/emermed-2014-203678. Epub 2014 Jun 10.
Unspecified chest pain is an important and potentially avoidable cause of emergency hospital admission. We aimed to examine inter-hospital variation in admission rates with unspecified chest pain and identify population characteristics, services and technologies that might explain this variation.
We used Hospital Episodes Statistics data from 152 acute trusts in England to calculate a direct standardised annual admission rate per 100,000 population for each trust. Regression analysis was used to identify factors explaining variation, first, using routinely available data relating to the hospital catchment area and service and then using responses to a survey of emergency department (ED) management.
The best predictors of admission rate using routine data were total beds per 1000 population (p=0.001), rapid access chest pain clinic (RACPC) attendances per year (p<0.001) and percentage of households in poverty (p=0.01). Including data from 105/142 (74%) survey responses, the best predictors of admission rate were total beds (p<0.001), RACPC attendances (p=0.001), mean ED waiting time (p=0.049) and percentage of households in poverty (p<0.001). All associations were positive (higher variable predicts higher rate) except ED waiting time. We found no significant associations between factors relating to acute chest pain management and admission rate.
Hospitals with higher admission rates for unspecified chest pain have greater bed provision, more RACPC attendances and serve populations with a higher percentage of households in poverty. These findings may be explained by services responding to demand in populations with greater need. We found no evidence that chest pain management influenced admission rates.
不明原因胸痛是急诊入院的一个重要且可能可避免的原因。我们旨在研究各医院间不明原因胸痛入院率的差异，并确定可能解释这种差异的人群特征、服务和技术。
我们使用了来自英格兰152家急性信托医院的医院事件统计数据，计算每家信托医院每10万人口的直接标准化年度入院率。首先，使用与医院服务区域和服务相关的常规可用数据，然后使用对急诊科管理调查的回复，通过回归分析来确定解释差异的因素。
使用常规数据时，入院率的最佳预测因素是每1000人口的病床总数（p = 0.001）、每年快速通道胸痛诊所（RACPC）的就诊人数（p < 0.001）以及贫困家庭百分比（p = 0.01）。纳入105/142（74%）的调查回复数据后，入院率的最佳预测因素是病床总数（p < 0.001）、RACPC就诊人数（p = 0.001）、急诊科平均等待时间（p = 0.049）以及贫困家庭百分比（p < 0.001）。除了急诊科等待时间外，所有关联都是正向的（变量越高，预测率越高）。我们发现与急性胸痛管理相关的因素与入院率之间没有显著关联。
不明原因胸痛入院率较高的医院病床供应更多、RACPC就诊人数更多，且服务的人群中贫困家庭百分比更高。这些发现可能是由于服务针对需求更大的人群的需求做出了响应。我们没有发现胸痛管理影响入院率的证据。
