医院流程综合表现与住院心脏骤停后患者结局的关联。
Association Between Hospital Process Composite Performance and Patient Outcomes After In-Hospital Cardiac Arrest Care.
机构信息
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle.
出版信息
JAMA Cardiol. 2016 Apr 1;1(1):37-45. doi: 10.1001/jamacardio.2015.0275.
IMPORTANCE
Survival rates after in-hospital cardiac arrest (IHCA) vary significantly among US centers; whether this variation is owing to differences in IHCA care quality is unknown.
OBJECTIVE
To evaluate hospital-level variation to determine whether hospital process composite performance measures of IHCA care quality are associated with patient outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Using data from the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) program, we analyzed 35 283 patients 18 years or older with IHCA treated at 261 US hospitals from January 1, 2010, through December 31, 2012. We calculated the hospital process composite performance score for IHCA using 5 guideline-recommended process measures. Opportunity-based scores were calculated for all patients, aggregated at the hospital level, divided into quartiles, and then associated with risk-standardized survival and neurologic status by a test for trend. The scores were then evaluated through hierarchical logistic regression and reported as odds ratios per 10% increment in hospital process composite performance.
INTERVENTIONS
Acute care treatments for IHCA.
MAIN OUTCOMES AND MEASURES
The primary outcome was survival to discharge measured as risk standard survival rates, and the secondary outcome was favorable neurologic status at hospital discharge.
RESULTS
Of the 35 283 adults included in this study, the median age was 67 years (interquartile range [IQR] 56-78 years), and 57.9% were male. The median IHCA hospital process composite performance was 89.7% (interquartile range, 85.4%-93.1%) and varied among hospital quartiles from 82.6% (lowest) to 94.8% (highest). The IHCA hospital process composite performance was linearly associated with risk-standardized hospital survival to discharge rates: 21.1%, 21.4%, 22.8%, and 23.4% from lowest to highest performance quartiles, respectively (P < .001). After adjustment, each 10% increase in a hospital's process composite performance was associated with a 22% higher odds of survival (adjusted odds ratio, 1.22; 95% CI, 1.08-1.37; P = .01). Hospital process composite quality performance was also associated with favorable neurologic status at discharge (P = .004).
CONCLUSIONS AND RELEVANCE
The quality of guideline-based care for IHCA varies significantly among US hospitals and is associated with patient survival and neurologic outcomes.
重要性
在美国各中心，院内心搏骤停（IHCA）后的生存率差异显著；这种差异是否归因于 IHCA 护理质量的差异尚不清楚。
目的
评估医院层面的变化，以确定 IHCA 护理质量的医院过程综合表现衡量标准是否与患者结局相关。
设计、地点和参与者：使用美国心脏协会 Get With the Guidelines-Resuscitation（GWTG-R）项目的数据，我们分析了 2010 年 1 月 1 日至 2012 年 12 月 31 日期间，261 家美国医院治疗的 35283 名年龄在 18 岁或以上的 IHCA 患者。我们使用 5 项指南推荐的过程衡量标准计算 IHCA 的医院过程综合表现得分。为所有患者计算机会得分，在医院层面进行汇总，分为四分位数，然后通过趋势检验与风险标准化的生存和神经状态相关联。然后通过分层逻辑回归进行评估，并报告每增加 10%的医院过程综合表现的优势比。
干预措施
急性 IHCA 治疗。
主要结局和衡量标准
主要结局是通过风险标准化的生存率来衡量的出院生存率，次要结局是出院时的良好神经状态。
结果
在这项研究的 35283 名成年人中，中位年龄为 67 岁（四分位距[IQR]56-78 岁），57.9%为男性。中位 IHCA 医院过程综合表现为 89.7%（IQR，85.4%-93.1%），医院四分位数之间存在差异，从最低的 82.6%到最高的 94.8%。IHCA 医院过程综合表现与风险标准化的出院生存率呈线性相关：最低至最高表现四分位数分别为 21.1%、21.4%、22.8%和 23.4%（P<0.001）。调整后，医院过程综合表现每增加 10%，生存的优势比就会增加 22%（调整优势比，1.22；95%置信区间，1.08-1.37；P=0.01）。医院过程综合质量表现也与出院时的良好神经状态相关（P=0.004）。
结论和相关性
美国各医院基于指南的 IHCA 护理质量差异显著，与患者生存率和神经结局相关。
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