医疗体系投入与患者报告结局：15 个国家成人先天性心脏病研究
Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries.
机构信息
KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.
Research Foundation Flanders (FWO), Brussels, Belgium.
出版信息
BMC Health Serv Res. 2020 Jun 3;20(1):496. doi: 10.1186/s12913-020-05361-9.
BACKGROUND
The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease.
METHODS
This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.
RESULTS
Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed.
CONCLUSIONS
This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
背景
医疗体系投入（如人力资源和基础设施）与死亡率之间的关系已得到广泛研究。然而，医疗体系投入与患者报告结局之间的关联尚不清楚。因此，我们探讨了各国医疗体系人力资源和基础设施与成人先天性心脏病患者报告结局之间的预测价值。
方法
这是一项横断面研究，纳入了来自 15 个国家的 3588 名先天性心脏病患者（中位年龄 31 岁；IQR=16.0；52%为女性；26%为简单缺陷，49%为中度缺陷，25%为复杂缺陷）。测量了以下患者报告结局：感知身心健康、心理困扰、健康行为和生活质量。评估的医疗体系投入包括：（i）人力资源（即每 1000 人中有多少医生和护士）和（ii）基础设施（即每 10000 人中有多少张医院床位）。采用一般线性混合模型进行单变量、多变量和敏感性分析，调整了患者特定变量和未测量的国家差异。
结果
敏感性分析显示，医生密度较高与自我报告的身心健康状况较好、心理困扰较少和生活质量较高显著相关。护士人数较多与自我报告的身体健康状况较好、心理困扰较少和健康行为风险较低显著相关。医院床位密度与患者报告结局之间无显著关联。
结论
这项探索性研究表明，以国家为单位衡量的卫生人力资源密度与成人先天性心脏病患者的报告结局相关。在得出关于观察到的关系的确定结论之前，还需要进行更多的研究。
试验注册
ClinicalTrials.gov：NCT02150603。于 2014 年 5 月 30 日注册。
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