Takada Daisuke, Kataoka Yuki, Morishita Tetsuji, Sasaki Noriko, Kunisawa Susumu, Imanaka Yuichi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan.
PLoS One. 2024 Dec 9;19(12):e0315217. doi: 10.1371/journal.pone.0315217. eCollection 2024.
Clinicians' research activities reportedly improve their healthcare performance. Presenting research at conferences may be related to improved patient care outcomes; however, few studies have investigated this relationship. Thus, we examined the association between presenting at conferences and the mortality of patients hospitalized for acute myocardial infarction.
We analyzed an administrative database of acute care hospitals in Japan. The study compared patients admitted to hospitals in which physicians made at least one conference presentation during the patient's admission year (Presentation Group) with those admitted to hospitals with no conference presentations (Control group). We performed multivariable logistic regression analyses to estimate the risk of all-cause in-hospital mortality. Five models were fitted: a Crude model, unadjusted; Model 1, adjusted for personal factors, including sex, age, Killip classification, and so on; Model 2, adjusted for Model 1 plus hospital factors; Model 3 was a multilevel analysis clustered by hospital codes and adjusted for the same variables as Model 1; Model 4 was adjusted for Model 1 plus evidence-based practices through causal mediation analysis.
After excluding 3,544 patients with missing Killip classification or ambulance use, data for 56,923 patients in 384 acute care hospitals were analyzed. Drug prescription in accordance with the evidence was significantly greater in the Presentation group than in the Control group. Moreover, conference presentation was significantly associated with lower in-hospital mortality in all models (Odds ratios (OR) = 0.68, 95% Confidence intervals (CIs): 0.65 to 0.72 in the Crude model; OR = 0.73, 95% CIs: 0.68 to 0.79 in Model 1; OR = 0.76, 95% CIs: 0.70 to 0.82 in Model 2; OR = 0.84, 95% CIs: 0.76 to 0.92 in Model 3; OR = 1.00, 95% CIs: 0.92 to 1.09 in Model 4).
The promotion of scholarly activities such as conference presentations might improve patient outcomes through increased evidence-based practice.
据报道，临床医生的研究活动可改善其医疗服务表现。在会议上展示研究成果可能与改善患者护理结果有关；然而，很少有研究调查这种关系。因此，我们研究了在会议上展示研究成果与因急性心肌梗死住院患者死亡率之间的关联。
我们分析了日本急性护理医院的行政数据库。该研究将在患者入院当年医生至少在一次会议上发表报告的医院收治的患者（展示组）与在没有会议报告的医院收治的患者（对照组）进行了比较。我们进行了多变量逻辑回归分析，以估计全因院内死亡率的风险。拟合了五个模型：一个粗模型，未调整；模型1，针对个人因素进行调整，包括性别、年龄、Killip分级等；模型2，在模型1的基础上加上医院因素进行调整；模型3是按医院代码聚类的多水平分析，并针对与模型1相同的变量进行调整；模型4通过因果中介分析在模型1的基础上加上循证实践进行调整。
在排除3544例Killip分级或救护车使用情况缺失的患者后，对384家急性护理医院的56923例患者的数据进行了分析。展示组中符合证据的药物处方显著多于对照组。此外，在所有模型中，会议报告与较低的院内死亡率显著相关（粗模型中比值比（OR）=0.68，95%置信区间（CI）：0.65至0.72；模型1中OR=0.73，95%CI：0.68至0.79；模型2中OR=0.76，95%CI：0.70至0.82；模型3中OR=0.84，95%CI：0.76至0.92；模型四OR=1.00，95%CI：0.92至1.09）。
促进学术活动，如会议报告，可能通过增加循证实践来改善患者结局。
