Li Qian, Lin Zhenqiu, Masoudi Frederick A, Li Jing, Li Xi, Hernández-Díaz Sonia, Nuti Sudhakar V, Li Lingling, Wang Qing, Spertus John A, Hu Frank B, Krumholz Harlan M, Jiang Lixin
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China.
BMC Cardiovasc Disord. 2015 Jan 20;15:9. doi: 10.1186/1471-2261-15-9.
China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited medical resources. Hospital length of stay (LOS) is an important indicator of resource utilization.
We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment of Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011. Hospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year, was examined with two-level generalized linear mixed models. A generalized estimating equation model was used to evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence intervals were reported.
The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and 12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level variation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on average 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics relating to capacity for AMI treatment were not associated with LOS.
Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained long compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix. Further improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary hospital variation.
面对有限的医疗资源，中国急性心肌梗死（AMI）的负担日益加重。住院时间（LOS）是资源利用的一项重要指标。
我们使用了中国心脏事件患者中心评估中的回顾性AMI研究数据，该研究是2001年、2006年和2011年期间因AMI住院患者的全国代表性样本。采用二级广义线性混合模型检验了AMI风险标准化住院时间（RS-LOS）的医院水平差异，该差异考虑了病例组合和年份的差异。使用广义估计方程模型评估与住院时间相关的医院特征。报告了RS-LOS的绝对差异和95%置信区间。
2001年（n = 1901）加权中位数和平均住院时间分别为13天和14.6天，2006年（n = 3553）为11天和12.6天，2011年（n = 7252）为11天和11.9天。在160家医院中，RS-LOS存在显著的医院水平差异，范围从9.2天到18.1天。中部地区的医院RS-LOS平均比东部地区的医院短1.6天（p = 0.02）。所有其他与AMI治疗能力相关的医院特征均与住院时间无关。
尽管在过去十年中有显著下降，但2011年中国AMI的平均住院时间与国际标准相比仍然较长。即使在调整病例组合后，医院间差异仍然很大。中国医院进一步改善AMI护理对于进一步缩短住院时间和减少不必要的医院差异至关重要。
