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.
65,3 %34,7% Median: 70,00
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 Data Used Comparison2007 Evolution
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.
Sample used for comparison
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 ,0 Distrital hospitals ,9 Level 1 distrital hospitals 2502,1 Fatality rate Fatality and survival rates Frequency% Central hospitals Fatalities ,9 Survival ,1 Distrital hospitals Fatalities ,2 Survival ,8 Level 1 distrital hospitals Fatalities 47 18,8 Survival ,2 Length of Stay Number of admissions Length of stay distribution (days) MedianMinMax Central hospitals 6, Distrital hospitals 7, Level 1 distrital hospitals 7,00071 Total 7,000203
Top 5 hospitals with lowest fatality rate Hospital code Number of admissions Fatality N(%) , , , , ,8 Bottom 5 hospitals with highest fatality rate Hospital code Number of admissions Fatality N(%) , , , , ,2 Top 5 hospitals with lowest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile Bottom 5 hospitals with highest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile
Top 5 hospitals with lowest fatality rate Hospital code Number of admissions Fatality N(%) , , , , ,0 Bottom 5 hospitals with highest fatality rate Hospital code Number of admissions Fatality N(%) , , , , ,8 Top 5 hospitals with lowest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile Bottom 5 hospitals with highest length of stay Hospital code Number of admissions Length of stay (days) Median Percentile 25 Percentile
Top 5 hospitals with lowest fatality rate Hospital code Number of admissions Fatality N(%) , , , ,8 Top 5 hospitals with lowest length of stay Hospital code Number of admissions Length of stay (days) MedianPercentile 25Percentile
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 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.
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