Reznik R, Ring I, Fletcher P, Berry G
Br Med J (Clin Res Ed). 1987 May 2;294(6580):1121-5. doi: 10.1136/bmj.294.6580.1121.
Hospitals ranging from large urban teaching hospitals to small country hospitals were stratified into four levels of care and examined for their effectiveness of coronary care in relation to these levels. The crude hospital mortality among 2265 patients admitted for definite or possible acute myocardial infarction was 21% at level 1 (the most elaborate level), 22% at level 2, 21% at level 3, and 19% at level 4 (the least elaborate). Adjustment for age or other prognostic factors produced no significant differences across levels either for coronary care unit care or for combined coronary unit and ward care. Success in resuscitation was also similar across levels. These findings suggest that increased resources for coronary care units--whether for new services or for upgrading existing ones--may not be required.
从大型城市教学医院到小型乡村医院，各类医院被分为四个护理级别，并针对这些级别对其冠心病护理效果进行了检查。2265名因确诊或疑似急性心肌梗死入院的患者中，一级护理（最精细的级别）的医院粗死亡率为21%，二级护理为22%，三级护理为21%，四级护理（最不精细的级别）为19%。对年龄或其他预后因素进行调整后，无论是冠心病监护病房护理还是冠心病监护病房与病房联合护理，各护理级别之间均无显著差异。各护理级别在复苏成功率方面也相似。这些发现表明，可能不需要为冠心病监护病房增加资源——无论是用于新服务还是升级现有服务。
