Rosenthal G E, Larimer D J, Owens K E
Department of Medicine, Cleveland Veterans Affairs Medical Center, OH 44106.
J Gen Intern Med. 1994 Aug;9(8):455-8. doi: 10.1007/BF02599064.
Comparisons of care in Veterans Affairs (VA) hospitals with care in non-VA hospitals are needed to define the future role of the VA health care system. Therefore, the authors conducted a retrospective cohort study of 385 patients who had acute myocardial infarctions and were admitted to a private nonprofit teaching hospital and to a university-affiliated VA hospital, which were staffed by attending and resident physicians from a single medicine department. Data were obtained from hospital databases and from patient records. The authors found that the 206 VA patients, compared with the 179 non-VA patients, were younger and more likely to be men. The VA patients also had higher comorbidity but lower admission severity of illness, according to previously validated measures. Although the VA patients were less likely than the non-VA patients to receive thrombolytic therapy (6% vs 20%, respectively; p < 0.05), they were more likely to undergo coronary angiography (67% vs 57%; p < 0.05) and echocardiography or gated blood pool scanning (54% vs 44%; p < 0.05) during hospitalization. Finally, the VA and the non-VA patients had similar rates of in-hospital mortality in univariate analysis (9% vs 11%, respectively; p = 0.4) and in multivariate analysis, adjusting for covariates. These results suggest that the VA and the non-VA patients who had acute myocardial infarction had similar outcomes and generally received care of similar qualities. Future studies are needed to explore the generalizability of these findings and to provide the data needed to adequately define the VA's future role in American health care.
需要对退伍军人事务部（VA）医院的护理与非VA医院的护理进行比较，以明确VA医疗保健系统未来的作用。因此，作者对385例急性心肌梗死患者进行了一项回顾性队列研究，这些患者分别入住一家私立非营利性教学医院和一家大学附属VA医院，两所医院均由来自单一内科的主治医生和住院医生提供服务。数据来自医院数据库和患者记录。作者发现，与179名非VA患者相比，206名VA患者更年轻，男性比例更高。根据先前验证的测量方法，VA患者的合并症更多，但入院时疾病严重程度更低。尽管VA患者接受溶栓治疗的可能性低于非VA患者（分别为6%和20%；p<0.05），但他们在住院期间接受冠状动脉造影的可能性更高（67%对57%；p<0.05），接受超声心动图或门控心血池扫描的可能性也更高（54%对44%；p<0.05）。最后，在单因素分析中，VA患者和非VA患者的院内死亡率相似（分别为9%和11%；p=0.4），在多因素分析中，对协变量进行调整后也是如此。这些结果表明，患有急性心肌梗死的VA患者和非VA患者的预后相似，总体上接受的护理质量也相似。未来需要开展研究，以探讨这些发现的普遍性，并提供充分界定VA在美国医疗保健中未来作用所需的数据。
