مقاله انگلیسی رایگان در مورد میزان مرگ و میر در بیماران مبتلا به سکته مغزی ایسکمیک حاد – الزویر ۲۰۲۰

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مشخصات مقاله
ترجمه عنوان مقاله ظرفیت بیمارستان و میزان مرگ و میر در بیماران مبتلا به سکته مغزی ایسکمیک حاد: تأثیر سازگاری برای شدت سکته مغزی
عنوان انگلیسی مقاله Hospital Volume and Mortality in Acute Ischemic Stroke Patients: Effect of Adjustment for Stroke Severity
انتشار مقاله سال ۲۰۲۰
تعداد صفحات مقاله انگلیسی ۹ صفحه
هزینه دانلود مقاله انگلیسی رایگان میباشد.
پایگاه داده نشریه الزویر
نوع نگارش مقاله
مقاله پژوهشی (Research Article)
مقاله بیس این مقاله بیس میباشد
نمایه (index) Scopus – Master Journals List – JCR – MedLine
نوع مقاله ISI
فرمت مقاله انگلیسی  PDF
ایمپکت فاکتور(IF)
۱٫۷۰۲ در سال ۲۰۱۹
شاخص H_index ۵۰ در سال ۲۰۲۰
شاخص SJR ۰٫۷۷۵ در سال ۲۰۱۹
شناسه ISSN ۱۰۵۲-۳۰۵۷
شاخص Quartile (چارک) Q2 در سال ۲۰۱۹
مدل مفهومی دارد
پرسشنامه ندارد
متغیر دارد
رفرنس دارد
رشته های مرتبط پزشکی
گرایش های مرتبط مغز و اعصاب
نوع ارائه مقاله
ژورنال
مجله  مجله سکته مغزی و بیماریهای مغزی-رگی – Journal Of Stroke And Cerebrovascular Diseases
دانشگاه Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
کلمات کلیدی بیماری مغزی-رگی/سکته مغزی، سکته مغزی ایسکمیک، کیفیت مراقبت، ظرفیت بیمارستان، شدت سکته مغزی
کلمات کلیدی انگلیسی Cerebrovascular disease/stroke، ischemic stroke، quality of care، hospital volume، stroke severity
شناسه دیجیتال – doi
https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104753
کد محصول E14681
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فهرست مطالب مقاله:
Abstract

Introduction

Methods

Results

Discussion

Conclusion

References

بخشی از متن مقاله:

Abstract

Objective: Stroke severity of 1 hospital is a crucial information when assessing hospital performance. We aimed to determine the effect of stroke severity in the association between hospital patient volume and outcome after acute ischemic stroke. Methods: Data from National Acute Stroke Quality Assessment in 2013 and 2014 were analyzed. Hospital patient volume was defined as the annual number of acute ischemic stroke patients who admitted to each hospital. Comparisons among hospital patient volume quartiles before and after adjusting age, sex, onset to arrival and stroke severity were made to determine the associations between hospital patient volume and mortality at 30 days, 90 days and 1 year. Assessments for the nonlinear associations, with treating hospital patient volume as a continuous variable, and the associations between hospital patient volume and quality of care were also made. Results: A total of 14,666 acute ischemic stroke patients admitted to 202 hospitals were analyzed. In the crude analysis, patients admitted to hospitals with lower patient volume showed higher mortality with a non-linear inverse association with a cut-off value of 227 patients/year. While the associations remained significant after adjusting age, sex and onset to arrival time (P’s < .05), they disappeared when stroke severity was further adjusted (P’s > .05). In contrary, hospital patient volume showed a nonlinear positive association with a plateau for summary measures of quality indicators even after adjustments for covariates including stroke severity (P < .001). Conclusions: Our study implicates that stroke severity should be considered when assessing hospital performance regarding outcomes of acute stroke care.

Introduction

Larger hospital patient volume generally correlates with better outcomes in various diseases or medical procedures. Previous studies showed that outcomes, which were mortality in most studies, were better in hospitals with larger patient volume than those with smaller one, and this relationship might be attenuated above a specific threshold. A study based on the Medicare claim data between 2004 and 2006 in the US reported that admission to higher-volume hospitals was associated with lower 30-day mortality for acute myocardial infarction, heart failure, and pneumonia, and there was a volume threshold, for example, 910 patients for acute myocardial infarction, above which a higher hospital patient volume had no impact on outcomes. However, another study based on the Get With The Guidelines-Heart Failure registry has reported that hospital patient volume was not associated with in-hospital and 30-day mortality but process measures in patients hospitalized with acute heart failure, which implicates that hospital patient volume would be a structure metric reflecting quality of hospital care rather than an outcome determinant. Similar results were replicated in stroke studies using large national databases. These studies showed an inverse relationship between hospital patient volume and mortality in acute stroke population as in other diseases. However, since it has been addressed that stroke severity is the most important prognostic factor for individual stroke patients and inclusion of a stroke severity measure in risk adjustment models for comparing hospital performance on outcomes is recommended, previous studies had their weakness of not including stroke severity in their multivariable models. Especially, previous studies showed that information on stroke severity is crucial for assessing one hospital’s performance, especially when mortality is used as an indicator of outcome. However, only 1 study from Denmark adjusted stroke severity for evaluating the effect of stroke patient volume on outcomes and reported that hospital patient volume was not associated with 30-day or 1-year mortality.

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