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心脏病患者由心脏病专家和非心脏病专家治疗的住院结局:一项倾向评分匹配研究。

Hospitalization outcome of heart diseases between patients who received medical care by cardiologists and non-cardiologist physicians: A propensity-score matched study.

作者信息

Wu Yu-Ming, Liu Chih-Chung, Yeh Chun-Chieh, Sung Li-Chin, Lin Chao-Shun, Cherng Yih-Giun, Chen Ta-Liang, Liao Chien-Chang

机构信息

Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

出版信息

PLoS One. 2020 Jul 6;15(7):e0235207. doi: 10.1371/journal.pone.0235207. eCollection 2020.

Abstract

BACKGROUND AND AIMS

The effects of physician specialty on the outcome of heart disease remains incompletely understood because of inconsistent findings from some previous studies. Our purpose is to compare the admission outcomes of heart disease in patients receiving care by cardiologists and noncardiologist (NC) physicians.

METHODS

Using reimbursement claims data of Taiwan's National Health Insurance from 2008-2013, we conducted a matched study of 6264 patients aged ≥20 years who received a cardiologist's care during admission for heart disease. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, and type of heart disease, 6264 controls who received an NC physician's care were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for complications and mortality during admission for heart disease associated with a cardiologist's care.

RESULTS

Patients who received a cardiologist's care had a lower risk of pneumonia (OR = 0.61; 95% CI, 0.53-0.70), septicemia (OR = 0.49; 95% CI, 0.39-0.61), urinary tract infection (OR = 0.76; 95% CI, 0.66-0.88), and in-hospital mortality (OR = 0.37; 95% CI, 0.29-0.47) than did patients who received an NC physician's care. The association between a cardiologist's care and reduced adverse events following admission was significant in both sexes and in patients aged ≥40 years.

CONCLUSION

We raised the possibility that cardiologist care was associated with reduced infectious complications and mortality among patients who were admitted due to heart disease.

摘要

背景与目的

由于既往一些研究结果不一致,医生专业对心脏病治疗结果的影响仍未完全明确。我们的目的是比较心脏病患者接受心脏病专家和非心脏病专家(NC)治疗后的住院结局。

方法

利用2008 - 2013年台湾全民健康保险的报销数据,我们对6264名年龄≥20岁、因心脏病住院期间接受心脏病专家治疗的患者进行了匹配研究。采用倾向得分匹配程序,根据社会人口学特征、病情和心脏病类型进行调整,选取了6264名接受NC医生治疗的对照。使用逻辑回归计算心脏病住院期间与心脏病专家治疗相关的并发症和死亡率的比值比(OR)及95%置信区间(CI)。

结果

与接受NC医生治疗的患者相比,接受心脏病专家治疗的患者发生肺炎(OR = 0.61;95% CI,0.53 - 0.70)、败血症(OR = 0.49;95% CI,0.39 - 0.61)、尿路感染(OR = 0.76;95% CI,0.66 - 0.88)和住院死亡率(OR = 0.37;95% CI,0.29 - 0.47)的风险更低。心脏病专家治疗与入院后不良事件减少之间的关联在男性和女性以及年龄≥40岁的患者中均显著。

结论

我们提出心脏病专家治疗可能与因心脏病入院患者的感染性并发症和死亡率降低有关。

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