Kitahata M M, Koepsell T D, Deyo R A, Maxwell C L, Dodge W T, Wagner E H
Department of Medicine, University of Washington, Seattle, WA 98122, USA.
N Engl J Med. 1996 Mar 14;334(11):701-6. doi: 10.1056/NEJM199603143341106.
Previous studies have found that patients with the acquired immunodeficiency syndrome (AIDS) who are admitted to hospitals that admit many such patients have lower mortality rates than patients in hospitals with less experience with AIDS. We examined the relation between physicians' experience with AIDS and the survival of their patients with AIDS.
We studied 403 adult male patients enrolled in a staff-model health maintenance organization in whom first AIDS-defining illnesses were diagnosed from 1984 through mid-1994; we determined that these illnesses met the 1987 case definition of the Centers for Disease Control. We defined three levels of experience for the patients' 125 primary care physicians according to their experience with AIDS during residency training and the cumulative number of patients with AIDS they had cared for in their practices.
The median survival of the patients of physicians with the least experience in the management of AIDS was 14 months, as compared with 26 months for the patients of physicians with the most experience (P<0.001). Controlling for the severity of illness and the year of diagnosis, we found that the patients cared for by physicians with the most experience had a 31 percent lower risk of death than the patients cared for by physicians with the least experience (P<0.02). Among 244 patients with an AIDS-defining illness diagnosed from 1989 through 1994, after adjustment for the CD4+ cell count and the severity of illness, the risk of death was 44 percent lower for patients of the most experienced physicians than for patients of the least experienced (P<0.02).
The experience of primary care physicians in the management of AIDS is significantly associated with survival among their patients.
先前的研究发现，入住收治大量获得性免疫缺陷综合征（AIDS）患者的医院的AIDS患者，其死亡率低于在AIDS治疗经验较少的医院中的患者。我们研究了医生的AIDS治疗经验与其AIDS患者生存率之间的关系。
我们研究了403名成年男性患者，他们参加了一个员工模式的健康维护组织，于1984年至1994年年中被诊断出首次出现符合AIDS定义的疾病；我们确定这些疾病符合疾病控制中心1987年的病例定义。根据患者的125名初级保健医生在住院医师培训期间的AIDS治疗经验以及他们在临床中护理过的AIDS患者的累积数量，我们将医生的经验分为三个级别。
AIDS管理经验最少的医生的患者的中位生存期为14个月，而经验最丰富的医生的患者为26个月（P<0.001）。在控制疾病严重程度和诊断年份后，我们发现经验最丰富的医生所护理的患者的死亡风险比经验最少的医生所护理的患者低31%（P<0.02）。在1989年至1994年被诊断出患有符合AIDS定义疾病的244名患者中，在调整CD4+细胞计数和疾病严重程度后，经验最丰富的医生的患者的死亡风险比经验最少的医生的患者低44%（P<0.02）。
初级保健医生的AIDS管理经验与他们患者的生存率显著相关。
