論文

査読有り
2014年

The relationship between the number of cardiologists and clinical practice patterns in acute heart failure: a cross-sectional observational study

BMJ OPEN
  • Noriko Sasaki
  • ,
  • Susumu Kunisawa
  • ,
  • Tetsuya Otsubo
  • ,
  • Hiroshi Ikai
  • ,
  • Kiyohide Fushimi
  • ,
  • Yoshio Yasumura
  • ,
  • Takeshi Kimura
  • ,
  • Yuichi Imanaka

4
12
開始ページ
e005988
終了ページ
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1136/bmjopen-2014-005988
出版者・発行元
BMJ PUBLISHING GROUP

Objectives: Despite the increasing burden of acute heart failure (AHF) on healthcare systems, the association between centralised cardiovascular specialist care and the quality of AHF care remains unknown. We examine the relationship between the number of cardiologists per hospital and hospital practice variations.
Design, setting and participants: In a retrospective observational study, we analysed 38 668 patients with AHF admitted to 546 Japanese acute care hospitals between 2010 and 2011 using the Diagnosis Procedure Combination administrative claims database. Sample hospitals were categorised into four groups according to the number of cardiologists per facility (none, 1-4, 5-9 and >= 10). To confirm the capability of administrative data to identify patients with AHF, the >= 10 cardiologists group was compared with two recent clinical registries in Japan.
Main outcome measures: Using multivariable logistic regression models, patient risk-adjusted in-hospital mortality rates and age-sex-adjusted ORs of various AHF therapies were calculated and compared among four hospital groups.
Results: The >= 10 cardiologists group of hospitals from the administrative database had similar major underlying disease incidence and therapeutic practices to those of the clinical registry hospitals. Age-adjusted and sex-adjusted ORs of various AHF therapies in the four hospital groups revealed wide practice variations associated with the number of cardiologists. Adjusted in-hospital mortality demonstrated a negative association with the number of cardiologists. In addition, the different hospital-level distribution patterns of specific therapeutic practices illustrated the diffusion process of therapies across facilities.
Conclusions: Wide practice variations in AHF care were associated with the number of cardiologists per facility, indicating a possible relationship between the quality of AHF care and manpower resources. The provision of recommended therapies increased together with the number of cardiologists.

Web of Science ® 被引用回数 : 6

リンク情報
DOI
https://doi.org/10.1136/bmjopen-2014-005988
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/25550294
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000355413900031&DestApp=WOS_CPL
ID情報
  • DOI : 10.1136/bmjopen-2014-005988
  • ISSN : 2044-6055
  • PubMed ID : 25550294
  • Web of Science ID : WOS:000355413900031

エクスポート
BibTeX RIS