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Kori S. Zachrison Jukka-Pekka Onnela Adrian Hernandez Mathew J. Reeves Carlos A. Camargo Margueritte Cox Roland A. Matsouaka Joshua P. Metlay Joshua N. Goldstein Lee H. Schwamm 《Journal of stroke and cerebrovascular diseases》2019,28(2):295-304
Background
Little is known about how hospitals are connected in the transfer of ischemic stroke (IS) patients. We aimed to describe differences in characteristics of transferred versus nontransferred patients and between transferring and receiving hospitals in the Northeastern United States, and to describe changes over time.Methods
We used Medicare claims data, and a subset linked with the Get with the Guidelines-Stroke registry from 2007 to 2011. Receiving hospitals were those with annual IS volume greater than or equal to 120 and greater than or equal to 15% received as transfers, and transferring hospitals were nonaccepting hospitals that transferred greater than or equal to 15% of their total (ED plus inpatient) IS patient discharges. A transferring-to-receiving hospital connection was identified if greater than or equal to 5 patients per year were shared. ArcGIS 10.3.1 was used for network visualization.Results
Among 177,270 admissions to 402 Northeast hospitals, 6906 (3.9%) patients were transferred. Transferred patients were younger with more severe strokes (78 versus 81 years, P < .001; National Institutes of Health Stroke Severity 7 versus 5, P < .001), and were as likely to receive tissue plasminogen activator as nontransferred (P = .29). From 2007 to 2011, there were more patients transferred (960 [3%] to 1777 [6%], P < .001), and more transferring hospitals (46 [12%] to 91 [24%], P < .001), and receiving hospitals (6 [2%] to 16 [4%], P < .001). Most transferring hospitals were exclusively connected to a single receiving hospital.Conclusions
From 2007 to 2011, hospitals in the United States Northeast became more connected in the care of IS patients, with increasing patient transfers and hospital connections. Yet most hospitals remained unconnected. Further characterization of this transfer network will be important for understanding and improving regional stroke systems of care. 相似文献4.
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卒中已成为全球第二大死亡病因和主要致残疾病。包括美国在内全球卒中医疗投入持续增长,但医疗质量却不容乐观。在过去的10余年,美国与卒中相关的组织和协会已开展不同的卒中医疗质量监测和持续改进项目推动美国卒中医疗质量的改善。本文就美国卒中医疗质量监测和持续改进的主要项目现状进行综述,以期供国内开展卒中医疗质量监测和改进项目提供借鉴。 相似文献
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