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Titolo:
Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI
Autore:
Allison, JJ; Kiefe, CI; Weissman, NW; Person, SD; Rousculp, M; Canto, JG; Bae, S; Williams, OD; Farmer, R; Centor, RM;
Indirizzi:
Univ Alabama, Ctr Outcomes & Effectiveness Res & Educ, Div Gen Internal Med,Dept Med, Dept Hlth Serv Adm,Sch Related Hlth Profess, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 th Profess, Birmingham, AL 35294 USA Univ Alabama, Ctr Outcomes & Effectiveness Res & Educ, Sch Related Hlth Profess,Div Prevent Med, Dept Med,Dept Hlth Serv Adm, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 h Serv Adm, Birmingham, AL 35294 USA Univ Alabama, Ctr Outcomes & Effectiveness Res & Educ, Sch Related Hlth Profess,Div Cardiovasc Med, Dept Med,Dept Hlth Serv Adm, Birmingham, AL 35294USA Univ Alabama Birmingham AL USA 35294 th Serv Adm, Birmingham, AL 35294USA Univ Alabama, Pittman Gen Clin Res Ctr, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 in Res Ctr, Birmingham, AL 35294 USA Univ Alabama, Lister Hill Ctr Hlth Policy, Birmingham, AL 35294 USA Univ Alabama Birmingham AL USA 35294 lth Policy, Birmingham, AL 35294 USA Vet Affairs Med Ctr, Birmingham, AL USA Vet Affairs Med Ctr Birmingham ALUSA ffairs Med Ctr, Birmingham, AL USA Alabama Qual Assurance Fdn, Birmingham, AL USA Alabama Qual Assurance FdnBirmingham AL USA nce Fdn, Birmingham, AL USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 10, volume: 284, anno: 2000,
pagine: 1256 - 1262
SICI:
0098-7484(20000913)284:10<1256:ROHTSW>2.0.ZU;2-U
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYOCARDIAL-INFARCTION; COOPERATIVE CARDIOVASCULAR PROJECT; SEVERITY-ADJUSTED MORTALITY; HEALTH-CARE; NONTEACHING HOSPITALS; RAPID CHANGES; DRUG-THERAPY; CENTERS; SYSTEM; COSTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
63
Recensione:
Indirizzi per estratti:
Indirizzo: Allison, JJ Univ Alabama, Ctr Outcomes & Effectiveness Res & Educ, Div GenInternal Med,Dept Med, Dept Hlth Serv Adm,Sch Related Hlth Profess, 1530 3rd Ave S,MEB621, Birmingham, AL 35294 USA Univ Alabama 1530 3rd Ave S,MEB 621 Birmingham AL USA 35294 SA
Citazione:
J.J. Allison et al., "Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI", J AM MED A, 284(10), 2000, pp. 1256-1262

Abstract

Context Issues of cost and quality are gaining importance in the delivery of medical care, and whether quality of care is better in teaching vs nonteaching hospitals is an essential question in this current national debate. Objective To examine the association of hospital teaching status with quality of care and mortality for fee-for-service Medicare patients with acute myocardial infarction (AMI). Design, setting, and Patients Analysis of Cooperative Cardiovascular Project data for 114411 Medicare patients from 4361 hospitals (22 354 patients from 439 major teaching hospitals, 22 493 patients from 455 minor teaching hospitals, and 69 564 patients from 3467 nonteaching hospitals) who had AMI between February 1994 and July 1995. Main Outcome Measures Administration of reperfusion therapy on admission, aspirin during hospitalization, and beta-blockers and angiotensin-converting enzyme inhibitors at discharge for patients meeting strict inclusion criteria; mortality at 30, 60, and 90 days and 2 years after admission. Results Among major teaching, minor teaching, and nonteaching hospitals, respectively, administration rates for aspirin were 91.2%, 86.4%, and 81.4% (P<.001); for angiotensin-converting enzyme inhibitors, 63.7%, 60.0%, and 58.0% (P<.001); for P-blockers, 48.8%, 40.3%, and 36.4% (P<.001); and for reperfusion therapy, 55.5%, 58.9%, and 55.2% (P = .29). Differences in unadjusted 30-day, 60-day, 90-day, and 2-year mortality among hospitals were significant at P<.001 for all time periods, with a gradient of increasing mortality from major teaching to minor teaching to nonteaching hospitals. Mortality differences were attenuated by adjustment for patient characteristics and were almost eliminated by additional adjustment for receipt of therapy. Conclusions In this study of elderly patients with AMI, admission to a teaching hospital was associated with better quality of care based on 3 of 4 quality indicators and lower mortality.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 08/07/20 alle ore 07:45:36