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首页> 外文期刊>International Journal for Quality in Health Care >Standard admission orders can improve the management of acute myocardial infarction
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Standard admission orders can improve the management of acute myocardial infarction

机译：标准的入院令可以改善急性心肌梗死的治疗

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Objective. To evaluate whether the use of standard admission orders for patients admitted with acute myocardial infarction (AMI) is associated with better hospital quality of care. Design. Secondary analysis of a population-based database derived from a large cluster randomized AMI quality improvement trial. Setting. Seventy-eight acute care hospital corporations located in Ontario, Canada. Participants. A total of 5338 patients with AMI admitted directly to the coronary care/intensive care units of participating hospitals in 2004/2005. Main outcome measure(s). Hospital performance on seven process-of-care measures and a combined composite process-of-care measure. Secondary outcomes were 30-day and 1-year mortality rates. Results. Most patients (81%) were treated with standard admission orders. These patients were more likely to receive four of seven identified process-of-care measures (P < 0.05), including fibrinolytics <=30 min or primary percutaneous coronary intervention <=90 min of arrival, fibrinolytics administration decided by emergency department physician, aspirin <=6 h of arrival and lipid test <=24 h. After propensity-score matching (for risk adjustment), use of standard admission orders was not associated with significantly lower 30-day or 1-year mortality. However, patients who met the composite process-of-care measure had lower 30-day and 1-year mortality (relative risk = 0.51 (95% confidence interval (CI): 0.40-0.67) and 0.70 (95% CI: 0.58-0.84), respectively). Conclusion. In AMI, the use of standard admission orders was associated with improved hospital performance on several but not all acute process-of-care quality indicators. The utilization of standard admission orders should be considered as a strategy for improving hospital care in patients admitted with AMI.
机译：目的。为了评估急性心肌梗塞（AMI）入院患者使用标准入院处方是否与更好的医院护理质量相关联。设计。从大型集群随机AMI质量改善试验获得的基于人群的数据库的二级分析。设置。位于加拿大安大略省的78家急诊医院公司。参加者2004/2005年，共有5338例AMI患者直接进入参与医院的冠心病监护/重症监护病房。主要观察指标）。七项护理过程措施和综合护理过程措施的医院绩效。次要结果为30天和1年死亡率。结果。大多数患者（81％）接受了标准的入院令。这些患者更有可能接受七种已确定的护理过程措施中的四种（P <0.05），包括纤溶剂<= 30分钟或初次经皮冠状动脉介入治疗<= 90分钟到达，由急诊科医师阿司匹林决定的纤溶剂管理<= 6小时到达，脂质测试<= 24小时。倾向得分匹配（用于风险调整）后，使用标准的入院令与30天或1年死亡率明显降低无关。但是，符合综合护理流程措施的患者的30天和1年死亡率较低（相对风险= 0.51（95％置信区间（CI）：0.40-0.67）和0.70（95％CI：0.58- 0.84））。结论。在AMI中，使用标准的入院令与改善几个而非全部急性护理过程质量指标的医院绩效有关。应考虑使用标准的入院令作为改善AMI入院患者住院治疗的策略。

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