美国斯坦福大学David C Chan团队研究了美国退伍军人急诊和在其他医院就诊后的死亡率。相关论文于2022年2月16日发表在《英国医学杂志》上。
为了衡量和比较救护车运送到退伍军人事务医院的具有双重保险资格的退伍军人与运送到非退伍军人事务医院的退伍军人之间的死亡率，研究组利用2001-2018年在美国46个州和哥伦比亚特区，救护车紧急访问的140家退伍军人事务医院和2622家非退伍军人事务医院的病历和管理档案的数据进行回顾性队列研究。
全国队列共包括583248名退伍军人（年龄≥65岁），均同时参加了退伍军人健康管理和医疗保险计划，居住在距离至少一家退伍军人事务医院和至少一家非退伍军人事务医院20英里以内的地区，救护车定期将患者送往这两类医院。主要结局为救护车行驶后30天内的死亡人数。使用了死亡率的线性概率模型，并对患者的人口统计学特征、居住邮政编码、共病情况和其他变量进行了校正。
共出动了1470157辆次救护车，其中231611人次（15.8%）送往退伍军人事务医院，1238546人次（84.2%）送往非退伍军人事务医院。在退伍军人事务医院接受治疗的患者中，30天的校正死亡率为每100名患者9.32例，比在非退伍军人事务医院接受治疗的患者（每100名中11.67例）低20.1%。退伍军人事务医院的死亡率优势对于黑人（−25.8%）和西班牙裔（−22.7%），以及上一年在同一家医院接受治疗的患者最为显著。
研究结果表明，在退伍军人事务医院接受急诊治疗的一个月内，双重保险资格退伍军人的死亡风险比在非退伍军人事务医院接受治疗的退伍军人低得多。这种死亡率优势的性质，以及它对其他类型患者和护理的普遍性值得进一步研究。尽管如此，这一发现与评估鼓励退伍军人使用私人医疗服务政策的价值有关。
附：英文原文
Title: Mortality among US veterans after emergency visits to Veterans Affairs and other hospitals: retrospective cohort study
Author: David C Chan, Kaveh Danesh, Sydney Costantini, David Card, Lowell Taylor, David M Studdert
Issue&Volume: 2022/02/16
Abstract:
Objective To measure and compare mortality outcomes between dually eligible veterans transported by ambulance to a Veterans Affairs hospital and those transported to a non-Veterans Affairs hospital.
Design Retrospective cohort study using data from medical charts and administrative files.
Setting Emergency visits by ambulance to 140 Veteran Affairs and 2622 non-Veteran Affairs hospitals across 46 US states and the District of Columbia in 2001-18.
Participants National cohort of 583248 veterans (aged ≥65 years) enrolled in both the Veterans Health Administration and Medicare programs, who resided within 20 miles of at least one Veterans Affairs hospital and at least one non-Veterans Affairs hospital, in areas where ambulances regularly transported patients to both types of hospitals.
Intervention Emergency treatment at a Veterans Affairs hospital.
Main outcome measure Deaths in the 30 day period after the ambulance ride. Linear probability models of mortality were used, with adjustment for patients’ demographic characteristics, residential zip codes, comorbid conditions, and other variables.
Results Of 1470157 ambulance rides, 231611 (15.8%) went to Veterans Affairs hospitals and 1238546 (84.2%) went to non-Veterans Affairs hospitals. The adjusted mortality rate at 30 days was 20.1% lower among patients taken to Veterans Affairs hospitals than among patients taken to non-Veterans Affairs hospitals (9.32 deaths per 100 patients (95% confidence interval 9.15 to 9.50) v 11.67 (11.58 to 11.76)). The mortality advantage associated with Veterans Affairs hospitals was particularly large for patients who were black (25.8%), were Hispanic (22.7%), and had received care at the same hospital in the previous year.
Conclusions These findings indicate that within a month of being treated with emergency care at Veterans Affairs hospitals, dually eligible veterans had substantially lower risk of death than those treated at non-Veterans Affairs hospitals. The nature of this mortality advantage warrants further investigation, as does its generalizability to other types of patients and care. Nonetheless, the finding is relevant to assessments of the merit of policies that encourage private healthcare alternatives for veterans.
DOI: 10.1136/bmj-2021-068099
Source: https://www.bmj.com/content/376/bmj-2021-068099
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
