Escarrabill Joan, Tebé Cristian, Espallargues Mireia, Torrente Elena, Tresserras Ricard, Argimón J
Hospital Clínic, Barcelona, España; Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Observatorio de las Terapias Respiratorias (Obs TRD). Departamento de Salud, CatSalut, AQuAS, PDMAR y Fundació d'Osona per a la Recerca i Educació Sanitària (FORES), Vic, Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España.
Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España.
Arch Bronconeumol. 2015 Oct;51(10):490-5. doi: 10.1016/j.arbres.2014.11.018. Epub 2015 Jan 21.
Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV). The aim of this study was to characterize the prevalence of HMV and variability in prescriptions from administrative data.
Prescribing rates of HMV in the 37 healthcare sectors of the Catalan Health Service were compared from billing data from 2008 to 2011. Crude accumulated activity rates (per 100,000 population) were calculated using systematic component of variation (SCV) and empirical Bayes (EB) methods. Standardized activity ratios (SAR) were described using a map of healthcare sectors.
A crude rate of 23 HMV prescriptions per 100,000 population was observed. Rates increase with age and have increased by 39%. Statistics measuring variation not due to chance show a high variation in women (CSV=0.20 and EB=0.30) and in men (CSV=0.21 and EB=0.40), and were constant over time. In a multilevel Poisson model, hospitals with a chest unit were associated with a greater number of cases (beta=0.68, P<.0001).
High variability in prescribing HMV can be explained, in part, by the attitude of professionals towards treatment and accessibility to specialist centers with a chest unit. Analysis of administrative data and variability mapping help identify unexplained variations and, in the absence of systematic records, are a feasible way of tracking treatment.
很少有研究分析家庭机械通气（HMV）的患病率和可及性。本研究的目的是根据行政数据描述HMV的患病率及处方的变异性。
利用2008年至2011年的计费数据，对比了加泰罗尼亚卫生服务机构37个医疗部门的HMV处方率。使用系统变异成分（SCV）和经验贝叶斯（EB）方法计算粗累积活动率（每10万人口）。利用医疗部门地图描述标准化活动比率（SAR）。
观察到每10万人口中有23例HMV处方的粗率。发病率随年龄增长而上升，且已上升了39%。衡量非偶然变异的统计数据显示，女性（CSV=0.20，EB=0.30）和男性（CSV=0.21，EB=0.40）的变异程度较高，且随时间保持不变。在一个多水平泊松模型中，设有胸科病房的医院病例数较多（β=0.68，P<0.0001）。
HMV处方的高变异性部分可归因于专业人员对治疗的态度以及进入设有胸科病房的专科中心的可及性。行政数据分析和变异制图有助于识别无法解释的变异，并且在缺乏系统记录的情况下，是跟踪治疗的一种可行方法。
