Chin M H, Wang J C, Zhang J X, Sachs G A, Lang R M
Department of Medicine, University of Chicago, IL, USA.
J Am Geriatr Soc. 1998 Nov;46(11):1349-54. doi: 10.1111/j.1532-5415.1998.tb06000.x.
To describe differences in the characteristics, processes of care, and resource utilization of patients with heart failure cared for by geriatricians, general internists, cardiologists, and combinations of physicians.
A retrospective cohort study.
An urban academic medical center.
A total of 439 outpatients with a billing diagnosis of heart failure or cardiomyopathy who were treated by geriatricians, general internists, cardiologists, and combinations of physicians.
Demographic and clinical characteristics, medication use, diagnostic testing, hospitalizations, and inpatient and outpatient costs were measured.
Compared with patients of cardiologists, patients cared for by geriatricians were older, more likely to have hypertension, diastolic dysfunction, and high comorbidity, and less likely to undergo echocardiography, cardiac catheterization, and electrocardiography. Use of angiotensin-converting enzyme inhibitors was similar among patients with reduced systolic function. Patients cared for by geriatricians had the same costs, rates of hospitalization, and likelihood of being symptomatic as patients of cardiologists.
The processes of care for patients with heart failure seen solely by geriatricians differ from those for patients seen by other physicians, but the case-mix also varies. Assessment of left ventricular function by geriatricians probably needs to be increased. However, although they were older and had more comorbidity, patients of geriatricians had total costs and symptomatology similar to those of patients of cardiologists. Future work is needed to identify those patients most likely to benefit from treatment by geriatricians and to determine how care can be optimally coordinated among different types of physicians and health providers.
描述由老年病科医生、普通内科医生、心脏病专家以及不同医生组合照料的心力衰竭患者在特征、护理过程和资源利用方面的差异。
一项回顾性队列研究。
一家城市学术医疗中心。
共有439名门诊患者，他们的计费诊断为心力衰竭或心肌病，接受了老年病科医生、普通内科医生、心脏病专家以及不同医生组合的治疗。
测量人口统计学和临床特征、药物使用情况、诊断检查、住院情况以及住院和门诊费用。
与心脏病专家的患者相比，由老年病科医生照料的患者年龄更大，更有可能患有高血压、舒张功能障碍和高合并症，接受超声心动图、心导管检查和心电图检查的可能性更小。收缩功能降低的患者中，血管紧张素转换酶抑制剂的使用情况相似。由老年病科医生照料的患者与心脏病专家的患者在费用、住院率和出现症状的可能性方面相同。
仅由老年病科医生照料的心力衰竭患者的护理过程与其他医生照料的患者不同，但病例组合也有所不同。可能需要增加老年病科医生对左心室功能的评估。然而，尽管老年病科医生的患者年龄更大且合并症更多，但他们的总费用和症状与心脏病专家的患者相似。未来需要开展工作，以确定最有可能从老年病科医生治疗中获益的患者，并确定如何在不同类型的医生和医疗服务提供者之间实现最佳的护理协调。
