Ritchie J L, Maynard C, Chapko M K, Every N R, Martin D C
Department of Medicine and Health Services Research and Development, Department of Veterans Affairs, Seattle, Washington, USA.
Am J Cardiol. 1998 May 1;81(9):1094-9. doi: 10.1016/s0002-9149(98)00125-8.
Coronary angioplasty is performed > 1,000 times daily in a variety of health care settings in the public and private sectors in the USA. How outcomes for this procedure differ in the Department of Veterans Affairs and the private sector is unknown. The purpose of this study was to compare outcomes of coronary angioplasty performed in hospitals in the Department of Veterans Affairs and the State of Washington. This study used administrative data from the Department of Veterans Affairs patient treatment file (n = 8,326) and the State of Washington episode of illness file (n = 6,666) and included men who underwent coronary angioplasty in 1993 and 1994. Outcomes included (1) in-hospital mortality and mortality at 10 and 30 days after hospital admission, and (2) the use of coronary artery bypass surgery at similar intervals. Patients with a principal diagnosis of acute myocardial infarction were analyzed separately. Men in the Department of Veterans Affairs had more comorbid conditions than their counterparts in Washington State, and the length of hospital stay was longer in the former group. After using logistic regression to adjust for patient differences, mortality rates for the 2 groups of patients with acute myocardial infarction were similar, although bypass surgery was used more frequently in patients in Washington State. For patients without myocardial infarction, hospital and 10-day mortality did not differ with respect to health care system, and the use of bypass surgery subsequent to angioplasty was similar. In the Department of Veterans Affairs, most hospitals had low institutional caseloads (< 150 procedures per year), whereas > 40% of Washington State hospitals performed > or = 300 procedures per year. Although there were greatly differing institutional caseloads, mortality and the need for early bypass surgery were similar in the 2 systems.
在美国，无论是公立还是私立医疗保健机构，每天进行的冠状动脉血管成形术都超过1000例。目前尚不清楚退伍军人事务部和私营部门在该手术的治疗效果上有何差异。本研究的目的是比较退伍军人事务部医院和华盛顿州医院进行冠状动脉血管成形术的治疗效果。本研究使用了退伍军人事务部患者治疗档案（n = 8326）和华盛顿州疾病发作档案（n = 6666）中的管理数据，纳入了1993年和1994年接受冠状动脉血管成形术的男性患者。治疗效果包括：（1）住院死亡率以及入院后10天和30天的死亡率；（2）相似时间段内冠状动脉搭桥手术的使用情况。对主要诊断为急性心肌梗死的患者进行了单独分析。退伍军人事务部的男性患者比华盛顿州的患者有更多的合并症，且前者的住院时间更长。在使用逻辑回归对患者差异进行调整后，两组急性心肌梗死患者的死亡率相似，尽管华盛顿州的患者更频繁地使用搭桥手术。对于没有心肌梗死的患者，医疗保健系统在住院死亡率和10天死亡率方面没有差异，血管成形术后搭桥手术的使用情况也相似。在退伍军人事务部，大多数医院的机构病例量较低（每年<150例手术），而华盛顿州超过40%的医院每年进行≥300例手术。尽管机构病例量差异很大，但两个系统在死亡率和早期搭桥手术需求方面相似。
