Alexander G Caleb, Garibaldi Brian T, An Huijun, Andersen Kathleen M, Robinson Matthew L, Wang Kunbo, Xu Yanxun, Betz Joshua F, Wu Albert W, Fisher Arielle, Egloff Shanna A, Sands Kenneth E, Mehta Hemalkumar B
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2025 Jan 1;63(1):9-17. doi: 10.1097/MLR.0000000000002086. Epub 2024 Oct 18.
Retrospective cohort study.
To characterize variation in dexamethasone and remdesivir use over time among hospitals.
Little is known about hospital-level variation in COVID-19 drug treatments in a large and diverse network in the United States.
We selected individuals hospitalized with COVID-19 across 163 hospitals between February 23, 2020 and October 31, 2021 from using the HCA CHARGE, an electronic health record repository from a network of community health care facilities in the United States. We quantified receipt of dexamethasone, remdesivir, and combined use of dexamethasone and remdesivir during the hospital stay. We used 2-level logistic regression models to determine the intraclass correlation coefficient (ICC) at the hospital level, adjusting for patient and hospital characteristics. The ICC shows the proportion of total variation in drug use accounted for by hospitals.
Among 161,667 individuals hospitalized with COVID-19, 73.0% were treated with dexamethasone, 49.1% with remdesivir, and 45.0% with both dexamethasone and remdesivir. The proportion of variation in dexamethasone use was 12.7% (adjusted ICC: 0.127), 8.5% for remdesivir, and 11.3% for combined drug use, indicating low interhospital variation. In the fully adjusted models, between-facility variation in dexamethasone use declined from 34.1% in February-March 2020 to 11.3% in January-March 2021 and then increased to 17.3% in July-October 2021. The variation in remdesivir use remained relatively stable during the study period.
During the first 2 years of the pandemic, there was relatively consistent use of dexamethasone and remdesivir across the hospitals examined. Consistent adoption and implementation of treatment guidelines across the hospitals examined may have led to a decrease in variation in drug usage over time.
回顾性队列研究。
描述各医院地塞米松和瑞德西韦使用随时间的变化情况。
在美国一个庞大且多样化的网络中，关于新冠病毒疾病药物治疗的医院层面差异，人们了解甚少。
我们从美国社区医疗设施网络的电子健康记录库HCA CHARGE中，选取了2020年2月23日至2021年10月31日期间在163家医院因新冠病毒疾病住院的患者。我们对住院期间地塞米松、瑞德西韦的使用情况以及地塞米松和瑞德西韦的联合使用情况进行了量化。我们使用二级逻辑回归模型来确定医院层面的组内相关系数（ICC），并对患者和医院特征进行了调整。ICC显示了医院在药物使用总差异中所占的比例。
在161,667例因新冠病毒疾病住院的患者中，73.0%接受了地塞米松治疗，49.1%接受了瑞德西韦治疗，45.0%同时接受了地塞米松和瑞德西韦治疗。地塞米松使用差异的比例为12.7%（调整后的ICC：0.127），瑞德西韦为8.5%，联合用药为11.3%，表明医院间差异较低。在完全调整后的模型中，地塞米松使用的机构间差异从2020年2月至3月的34.1%降至2021年1月至3月的11.3%，然后在2021年7月至10月升至17.3%。在研究期间，瑞德西韦使用的差异保持相对稳定。
在疫情的头两年，在所研究的医院中，地塞米松和瑞德西韦的使用相对一致。在所研究的医院中，治疗指南的持续采用和实施可能导致了药物使用差异随时间的减少。
