Presentation on theme: "Introdução à Medicina I Class 11 Adviser: Dr. Armando Teixeira Pinto Faculdade de Medicina da Universidade do Porto Curso de Mestrado Integrado em Medicina."— Presentation transcript:
Introdução à Medicina I Class 11 Adviser: Dr. Armando Teixeira Pinto Faculdade de Medicina da Universidade do Porto Curso de Mestrado Integrado em Medicina 2008/2009
Faculdade de Medicina da Universidade do Porto Comparison and Evolution of Medical Care of Inpatients with Acute Myocardial Infarction in Portuguese Public Hospitals
Acute myocardial infarction (AMI – ICD9 410) is one of the major causes of death among Western civilization. Such studies are not widespread among Portuguese institutions Access to hospitals admnistrative data. Introduction Background and Justification
Understanding the general quality concerning the treatment of AMI in Portuguese Public Hospitals. It may create the need for improvement. Stimulating further analysis and future studies. Providing a guide for general population.
Medical term for heart attack. Caused by the blockage of the coronary arteries which will lead to an insufficient blood suply to the heart muscle (myocardium).
RESEARCH QUESTION What is the status of medical care system in Portugal for AMI and how has it evolved throughout the years? What is the geographical distribution of AMI incidence in mainland Portugal? AIMS Compare different Portuguese areas according to 2 criteria Compare hospitals quality based on 2 criteria. Evaluate the improvements of medical care in hospitals.
2001 Relative frequency of admissions distributionFatality rate distribution
2007 Relative frequency of admissions distributionFatality rate distribution
Total number of admissions with AMI, fatality rate and median length of stay in the hospital, per year of admission (total n= 91133)
Median: 7 days Length of StayFatality/Survival rate FatalitiesSurvivals 12,587,5
Transversal and longitudinal Study Data: from all Portuguese Public Hospitals, from 2000 to 2007. Data Used Comparison2007 Evolution2000-2007
Variables: Number of admissions; Lenght of Stay; Fatality rate: FR = Number of deaths caused by AMI Number of Admissions by AMI Extract of the databases codes Participants and Methods Data and Variables
According to the newest hospital classification: Central hospitals– Including the main hospitals of the main regions in Portugal; Distrital hospitals– Including the main hospitals of secondary regions in Portugal; Level 1 distrital hospitals – Including the smallest hospitals.
By type of hospital Number of admissions Fatality / Survival Rates Length of stay Central hospitals Fatality rate Length of stay Distrital hospitals Fatality rate Length of stay Level 1 distrital hospitals Fatality rate Length of stay
Distribution according to hospital type Frequency% Central hospitals 471940,0 Distrital hospitals 683457,9 Level 1 distrital hospitals 2502,1 Fatality rate Fatality and survival rates Frequency% Central hospitals Fatalities 516 10,9 Survival 4203 89,1 Distrital hospitals Fatalities 766 11,2 Survival 6068 88,8 Level 1 distrital hospitals Fatalities 47 18,8 Survival 203 81,2 Length of Stay Number of admissions Length of stay distribution (days) MedianMinMax Central hospitals 6,000203 Distrital hospitals 7,000119 Level 1 distrital hospitals 7,00071 Total 7,000203
Top 5 hospitals with lowest fatality rate Hospital code Number of admissions Fatality N(%) 120 758476,2 226 431317,2 374 423327,6 47 505479,3 590 408409,8 Bottom 5 hospitals with highest fatality rate Hospital code Number of admissions Fatality N(%) 925 2813612,8 1045 1442114,6 1116 4417316,6 1250 3095818,8 1332 651929,2 Top 5 hospitals with lowest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile 75 150 309437 245 1444011 37 505537 496 342548 574 423649 Bottom 5 hospitals with highest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile 75 990 408649 1032 657216 1125 2817413 1220 7587512 1387 977512
Top 5 hospitals with lowest fatality rate Hospital code Number of admissions Fatality N(%) 179 5423,7 255 234114,7 367 255155,9 471 6845,9 577 232146,0 Bottom 5 hospitals with highest fatality rate Hospital code Number of admissions Fatality N(%) 3219 1252318,4 3337 731419,2 344 14321,4 3556 13323,1 3631 1414229,8 Top 5 hospitals with lowest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile 75 181 1142011 28 504436 392 192529 436 4335410 577 232649 Bottom 5 hospitals with highest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile 75 3275 599514 3337 7310614 3431 14111517 3544 18712716 3679 5412718
Top 5 hospitals with lowest fatality rate Hospital code Number of admissions Fatality N(%) 147 6146,6 258 27311,1 329 961919,8 43 12325 582 23834,8 Top 5 hospitals with lowest length of stay Hospital code Number of admissions Length of stay (days) MedianPercentile 25Percentile 75 13 1241 282 235211 358 27659 429 968413 547 618611
The evolution of fatality rates and median length of stay throughout the years, for central, distrital and level 1 distrital hospitals ---- Median length of stay ___ Fatality rate
EVOLUTION Regarding the fatality rate: No significant variation was observed for distrital and central hospitals. A slight increase was observed for type 1 distrital hospitals. These results should not be linearly associated to a decrease in the quality of medical care provided as various factors could be related to this (ex: older population). Regarding the length of stay: a very slight decrease was observed, more evident between the years of 2000 and 2002 and between 2004 and 2006. This can be connected to structural and organizational modifications in SNS hospitals, like the introduction of Hospitais SA in 2002 and Hospitais EPE in 2004.
COMPARISON As expected, there were significant differences between the three types of hospitals. Admittance of an association between lower fatality rate and lower length of stay. Possible indicators in the quality of care provided.
Information relative to the year 2007 (some changes may have occured since). Possible information bias in the database. No information ab0ut procedures.
PladevalL M, Goff D C, Nichaman MZ, Chan F, Ramsey D, Ortiz C, Labarthe DR. An Assessment of the Validity of ICD Code 410 to Identify Hospital Admissions for Myocardial Infarction: The Corpus Christi Heart Project. International Journal of Epidemiology [Internet]. 1996 March [Cited 1996 Oct]; 25:948-52. Available from: http://ije.oxfordjournals.org/cgi/reprint/25/5/948 Brahmajee KN, Wang Y, Cram P, Birkmeyer JD, Ross JS, Normand S-LT, Krumholz HM. Specialty Cardiac Hospitals Acute Myocardial Infarction and Congestive Heart Failure Outcomes. Journal Of The American Heart Association [Internet]. 2007 Oct 29 [Cited 2007 Nov 13]; 116:2280-2287. Available from: http://circ.ahajournals.org/cgi/content/full/116/20/2280 Wang OJ, Wang Y, Lichtman JH, Bradley EH, Normand S-LT, Krumholz HM. Americas Best Hospitals in the Treatment of Acute Myocardial Infarction. Arch Intern Med [Internet]. 2007 Jan 3 [Cited 2007 Jul 9];167(13):1345-1351. Available from: http://archinte.ama-assn.org/cgi/reprint/167/13/1345 Younga L, Donaldc M, Parr M, Hillmana K. The Medical Emergency Team system: A two hospital Comparison. Resuscitation [Internet]. 2007 Nov 20 [Cited 2008 May]; 77:180-188. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(07)00641-7 Madsen M, Davidsen M, Rasmussen S, Abildstrom SJ, Osler M. The validity of the diagnosis of acute myocardial infarction in routine statistics: A comparison of mortality and hospital discharge data with the Danish MONICA registry. Journal of Clinical Epidemiology [Internet]. 2002 Oct 15. [Cited 2003 Feb]; 56: 124-130. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0895435602005917 Lutfiyya MN, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper V, Lipsky MS. A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. International Journal for Quality in Health Care [Internet]. 2007 April 18. [Cited 2007 Jun]; 19 (3): 141-149. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0895435602005917 Tu JV, Khalid L, Donovan LR, Ko DT. Indicators of quality of care for patients with acute myocardial infarction. CMAJ [Internet]. [Cited 2008 Oct 21]; 179(9):909-915. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2565729&blobtype=pdf Westfall JM, Kiefe CI, Weissman NW, Goudie A, Centor RM, Williams OD, Allison JJ. Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project. BMC Cardiovascular Disorders [Internet]. [Cited 2008 Sep 9]; 8: 1471- 1480. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2551582&blobtype=pdf Spertus JA, Radford MJ, Every NR, MD, Ellerbeck EF, Peterson ED, Krumholz HM. Challenges and Opportunities in Quantifying the Quality of Care for Acute Myocardial Infarction. JACC [Internet]. [Cited 2003 May 7]; 41(9): 1653-1663. Available from: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T18-48H8FH4-16- 3&_cdi=4884&_user=10&_orig=search&_coverDate=05%2F07%2F2003&_sk=999589990&view=c&wchp=dGLbVlz- zSkWA&md5=c01aa03e9155ba3052b8885674bb415e&ie=/sdarticle.pdf Spertus JA, Eagle KA, Krumholz HM, Mitchell KR, Normand S-LT. American College of Cardiology and American Heart Association Methodology for the Selection and Creation of Performance Measures for Quantifying the Quality of Cardiovascular Care. Journal Of The American Heart Association [Internet]. 2005 Jan 25 [Cited 2005 Apr 5]; 111: 1703-1712. Available from: http://circ.ahajournals.org/cgi/reprint/111/13/1703 Romano PS, Chan BK. Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? Health Serv Res [Internet]. [Cited 2000 Mar]; 34(7): 1469–1489. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1975668&blobtype=pdf Association AH. Acute myocardial infarction [Internet]. Greenville Avenue Dallas (TX): American Heart Association. Available from: http://www.americanheart.org/presenter.jhtml?identifier=3061532 Costa C, Os Melhores Hospitais Doença a Doença. Sábado. 2007 Nov 8; 184(1):6-21. Costa C, Os Melhores Hospitais Para Cada Doença. Sábado. 2008 Nov 8; 239 (2):44-58. References