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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >The Patterns and Outcomes of Inter-Hospital Transfer Among Medicare Patients with Ischemic Stroke
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The Patterns and Outcomes of Inter-Hospital Transfer Among Medicare Patients with Ischemic Stroke

机译：医疗患者缺血性卒中患者医院间转移的模式和结果

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Background and Purpose: Inter-hospital transfer for ischemic stroke is an essential part of stroke system of care. This study aimed to understand the national patterns and outcomes of ischemic stroke transfer. Methods and Results: This retrospective study examined Medicare beneficiaries aged >= 65 years undergoing inter-hospital transfer for ischemic stroke in 2012. Cox proportional hazards model was used to compare 30-day and one-year mortality between transferred patients and direct admissions from the emergency department (ED admissions). Among 312,367 ischemic stroke admissions, 5.7% underwent inter-hospital transfer. Using this value as cut-off, the hospitals were classified into receiving (n = 411), sending (n = 559), and low-transfer (n = 1863) hospitals. Receiving hospitals were larger than low-transfer and sending hospitals as demonstrated by the median bed number (371, 189, and 88, respectively, p < 0.001); more frequently to be certified stroke centers (75%, 47%, and 16%, respectively, p < 0.001); and less commonly located in the rural area (2%, 7%, and 24%, respectively, p < 0.001). For receiving hospitals, transfer-in patients and ED admissions had comparable mortality at 30 days (10% vs 10%; adjusted HR [aHR]=1.07; 95% CI, 0.99-1.14) and 1 year (23% vs 24%; aHR=1.03; 95% CI, 0.99-1.08). For sending hospitals, transfer-out patients, compared to ED admissions, had higher mortality at 30 days (14% vs 11%; aHR=1.63; 95% CI, 1.39-1.91) and 1 year (30% vs 27%; aHR=1.33; 95% CI, 1.20-1.48). For low-transfer hospitals, overall transfer-in and transfer-out patients, compared to ED admissions, had higher mortality at 30 days (13% vs 10%; aHR=1.46; 95% CI, 1.33-1.60) and 1 year (28% vs 25%; aHR=1.27; 95% CI, 1.19-1.36). Conclusions: Hospitals in the US, based on their transfer patterns, could be classified into 3 groups that shared distinct characteristics including hospital size, rural vs urban location, and stroke certification. Transferred patients at sending and low-transfer hospitals had worse outcomes than their ED admission counterpart.
机译：背景和目的：缺血性卒中的院间转运是卒中护理体系的重要组成部分。本研究旨在了解缺血性中风转移的国家模式和结果。方法和结果：这项回顾性研究调查了2012年65岁以上因缺血性中风接受院间转移的医疗保险受益人。Cox比例风险模型用于比较转移患者和急诊科直接入院患者（ED入院）的30天和一年死亡率。在312367例缺血性中风入院患者中，5.7%接受了院内转移。将该值作为截止值，将医院分为接收（n=411）、发送（n=559）和低转移（n=1863）医院。接收医院的病床数中位数（分别为371张、189张和88张，p<0.001）显示，接收医院大于低转移医院和发送医院；更频繁地成为认证卒中中心（分别为75%、47%和16%，p<0.001）；在农村地区不太常见（分别为2%、7%和24%，p<0.001）。对于接受治疗的医院而言，入住转诊患者和急诊入院患者在30天时的死亡率（10%对10%；调整后的HR[aHR]=1.07；95%可信区间为0.99-1.14）和1年时的死亡率（23%对24%；aHR=1.03；95%可信区间为0.99-1.08）具有可比性。对于送往医院的患者，与急诊入院患者相比，转出患者在30天（14%比11%；aHR=1.63；95%可信区间1.39-1.91）和1年（30%比27%；aHR=1.33；95%可信区间1.20-1.48）时的死亡率更高。对于低转移医院，与急诊入院患者相比，整体转入和转出患者在30天（13%对10%；aHR=1.46；95%可信区间1.33-1.60）和1年（28%对25%；aHR=1.27；95%可信区间1.19-1.36）时的死亡率更高。结论：根据转移模式，美国的医院可分为三类，它们具有不同的特征，包括医院规模、农村与城市位置以及中风认证。转院和低转院医院的转院患者的预后比急诊入院患者差。

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