卒中患者周末入院的医疗服务重组与死亡率的关系：一项基于行政数据的全国描述性研究。

Reorganisation of stroke care and impact on mortality in patients admitted during weekends: a national descriptive study based on administrative data.

机构信息

Primary Care and Public Health, Imperial College London, London, UK.

Stroke Medicine, Royal United Hospital Bath NHS Foundation Trust, Bath, UK.

出版信息

BMJ Qual Saf. 2018 Aug;27(8):611-618. doi: 10.1136/bmjqs-2017-006681. Epub 2017 Oct 27.

DOI:10.1136/bmjqs-2017-006681

PMID:29079641

Abstract

OBJECTIVE

To evaluate mortality differences between weekend and weekday emergency stroke admissions in England over time, and in particular, whether a reconfiguration of stroke services in Greater London was associated with a change in this mortality difference.

DESIGN, SETTING AND PARTICIPANTS: Risk-adjusted difference-in-difference time trend analysis using hospital administrative data. All emergency patients with stroke admitted to English hospitals from 1 January 2008 to 31 December 2014 were included.

MAIN OUTCOMES

Mortality difference between weekend and weekday emergency stroke admissions.

RESULTS

We identified 507 169 emergency stroke admissions: 26% of these occurred during the weekend. The 7-day in-hospital mortality difference between weekend and weekday admissions declined across England throughout the study period. In Greater London, where the reorganisation of stroke services took place, an adjusted 28% (relative risk (RR)=1.28, 95% CI 1.09 to 1.47) higher weekend/weekday 7-day mortality ratio in 2008 declined to a non-significant 9% higher risk (RR=1.09, 95% CI 0.91 to 1.32) in 2014. For the rest of England, a 15% (RR=1.15, 95% CI 1.09 to 1.22) higher weekend/weekday 7-day mortality ratio in 2008 declined to a non-significant 3% higher risk (RR=1.03, 95% CI 0.97 to 1.10) in 2014. During the same period, in Greater London an adjusted 12% (RR=1.12, 95% CI 1.00 to 1.26) weekend/weekday 30-day mortality ratio in 2008 slightly increased to 14% (RR=1.14, 95% CI 1.00 to 1.30); however, it was not significant. In the rest of England, an 11% (RR=1.11, 95% CI 1.07 to 1.15) higher weekend/weekday 30-day mortality ratio declined to a non-significant 4% higher risk (RR=1.04, 95% CI 0.99 to 1.09) in 2014. We found no statistically significant association between decreases in the weekend/weekday admissions difference in mortality and the centralisation of stroke services in Greater London.

CONCLUSIONS

There was a steady reduction in weekend/weekday differences in mortality in stroke admissions across England. It appears statistically unrelated to the centralisation of stroke services in Greater London, and is consistent with an overall national focus on improving stroke services.

摘要

目的

评估英国急诊中风入院患者周末与工作日死亡率的差异随时间的变化情况，特别是伦敦大区中风服务重组是否与这种死亡率差异的变化有关。

设计、地点和参与者：使用医院管理数据进行风险调整的差异-差异时间趋势分析。纳入 2008 年 1 月 1 日至 2014 年 12 月 31 日期间英格兰所有因中风急症入院的患者。

主要结局

周末与工作日急诊中风入院患者死亡率的差异。

结果

我们共识别出 507169 例急诊中风患者：其中 26%的患者在周末入院。在整个研究期间，英格兰各地周末与工作日住院 7 天死亡率的差异呈下降趋势。在伦敦大区，中风服务重组发生的地方，2008 年周末/工作日 7 天死亡率比值的调整后差值高出 28%（相对风险（RR）=1.28，95%置信区间（CI）为 1.09 至 1.47），但在 2014 年，这一比值下降至非显著的高出 9%（RR=1.09，95% CI 0.91 至 1.32）。在英格兰其他地区，2008 年周末/工作日 7 天死亡率比值高出 15%（RR=1.15，95% CI 1.09 至 1.22），但在 2014 年，这一比值下降至非显著的高出 3%（RR=1.03，95% CI 0.97 至 1.10）。在同一时期，伦敦大区周末/工作日 30 天死亡率比值的调整后差值高出 12%（RR=1.12，95% CI 1.00 至 1.26），从 2008 年的 12%上升至 14%（RR=1.14，95% CI 1.00 至 1.30）；但差异无统计学意义。在英格兰其他地区，周末/工作日 30 天死亡率比值高出 11%（RR=1.11，95% CI 1.07 至 1.15），但在 2014 年下降至非显著的高出 4%（RR=1.04，95% CI 0.99 至 1.09）。我们未发现周末/工作日入院死亡率差异的减少与伦敦大区中风服务的集中化之间存在统计学上的关联。