Zhou Yuqi, Yao Xi, Liu Guofeng, Jian Weiyan, Yip Winnie
School of Public Health, Peking University Health Science Center, Beijing, China.
Center for Health Policy and Technology Evaluation, Peking University Health Science Center, Beijing, China.
BMC Health Serv Res. 2019 Jan 18;19(1):43. doi: 10.1186/s12913-019-3872-0.
Quality of care (QoC) attracts global concerns when unsafe and misuse of healthcare wastes resources and endangers people's health, especially in low- and middle-income countries. However, little is known about quality of care delivered in China. This study was intended to gauge the quality of care for acute myocardial infarction (AMI) patients in Beijing and identify the quality gaps across tertiary hospitals.
One thousand two hundred twenty eight patients, covered by Employee Essential Health Insurance Scheme and diagnosed of AMI, was sampled from 14 large comprehensive hospitals in Beijing, China. Chart review study was conducted through the discharge data and medical records of inpatients to evaluate 6 quality outcomes of interest, including the use of aspirin, beta blocker, and statin at discharge; use of aspirin within 24 h at arrival; angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD); percutaneous transluminal coronary intervention (PCI) within 90 min at arrival.
Of the 1228 subjects, the mean age was 60.8 (11.8 SD) years and 83.0% were male. The overall medication prescribed was highly compliant with the clinical guidelines (97.0% [95% CI 96.8-97.2] for aspirin and 96.3% [95% CI 96.0-96.5] for statin), except for beta-blocker (83.6% [95% CI 83.0-84.1]) and ACEI/ARB use (61.4% [95% CI 60.7-62.2]). More than half of eligible patients did not receive appropriate PCI therapy (44.0% [95% CI 42.5-45.4]). Great variations across hospitals was observed in aspirin within 24 h and beta-blocker at discharge (P < 0.001), and the risk-adjusted results remained robust.
Underuse of recommended treatment and significant variations of quality were found for AMI patients across tertiary hospitals in Beijing. It raised great concerns on poorer quality of care in other less-developed areas with less medical resources. Practical actions are needed in reducing quality gaps to ensure the delivery of quality care.
当医疗保健的不安全和不当使用浪费资源并危及人们的健康时，医疗质量（QoC）引起了全球关注，尤其是在低收入和中等收入国家。然而，对于中国提供的医疗质量知之甚少。本研究旨在评估北京急性心肌梗死（AMI）患者的医疗质量，并确定三级医院之间的质量差距。
从中国北京的14家大型综合医院中抽取了1228名参加职工基本医疗保险计划并被诊断为AMI的患者。通过出院数据和住院患者病历进行图表回顾研究，以评估6项感兴趣的质量结果，包括出院时阿司匹林、β受体阻滞剂和他汀类药物的使用；入院后24小时内使用阿司匹林；用于左心室收缩功能障碍（LVSD）的血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）；入院后90分钟内进行经皮冠状动脉介入治疗（PCI）。
在1228名受试者中，平均年龄为60.8（标准差11.8）岁，男性占83.0%。除β受体阻滞剂（83.6%[95%置信区间83.0-84.1]）和ACEI/ARB的使用（61.4%[95%置信区间60.7-62.2]）外，总体用药情况高度符合临床指南（阿司匹林为97.0%[95%置信区间96.8-97.2]，他汀类药物为96.3%[95%置信区间96.0-96.5]）。超过一半的符合条件的患者未接受适当的PCI治疗（44.0%[95%置信区间42.5-45.4]）。在入院后24小时内使用阿司匹林和出院时使用β受体阻滞剂方面，各医院之间存在很大差异（P<0.001），风险调整后的结果仍然很显著。
在北京的三级医院中，AMI患者存在推荐治疗的使用不足和质量的显著差异。这引发了对其他医疗资源较少的欠发达地区医疗质量较差的极大关注。需要采取实际行动来缩小质量差距，以确保提供高质量的医疗服务。
