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Introdução à Medicina I Class 11 Adviser : Dr. Armando Teixeira Pinto

Introdução à Medicina I Class 11 Adviser : Dr. Armando Teixeira Pinto. Faculdade de Medicina da Universidade do Porto Curso de Mestrado Integrado em Medicina 2008/2009. Comparison and Evolution of Medical Care of Inpatients with Acute Myocardial Infarction in Portuguese Public Hospitals.

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Introdução à Medicina I Class 11 Adviser : Dr. Armando Teixeira Pinto

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  1. Introdução à Medicina IClass 11Adviser: Dr. Armando Teixeira Pinto Faculdade de Medicina da Universidade do Porto Curso de Mestrado Integrado em Medicina 2008/2009

  2. Comparison and Evolution of Medical Care of Inpatients with Acute Myocardial Infarction in Portuguese Public Hospitals Faculdade de Medicina da Universidade do Porto

  3. Introduction Background and Justification • Acute myocardial infarction (AMI – ICD9 410) is one of the major causes of death among Western civilization. • Such studies are not widespread among Portuguese institutions • Access to hospitals’ admnistrative data.

  4. Value • Understandingthe general qualityconcerningthetreatmentof AMI inPortuguesePublicHospitals. • Itmaycreatetheneed for improvement. • Stimulatingfurtheranalysisandfuturestudies. • Providing a guide for general population.

  5. Age-standardised death rates per 100,000 population from AMI, from 1972 to 2002, in Portugal

  6. AcuteMyocardialInfarction (AMI) • Medical term for heart attack. • Caused by the blockage of the coronary arteries which will lead to an insufficient blood suply to the heart muscle (myocardium).

  7. Research Question and Aims RESEARCH QUESTION • What is the status of medical care system in Portugal for AMI and how has it evolved throughout the years? • What is the geographical distribution of AMI incidence in mainland Portugal? AIMS • Compare different Portuguese areas according to 2 criteria • Compare hospitals’ quality based on 2 criteria. • Evaluatetheimprovementsofmedicalcareinhospitals.

  8. ParticipantsandMethodsSample

  9. SampleAge andgender

  10. SampleGeographicdistribution

  11. SampleGeographicdistribution

  12. SampleEvolution Total number of admissions with AMI, fatality rate and median length of stay in the hospital, per year of admission (total n= 91133)

  13. Sample LengthofStay Fatality/Survival rate

  14. Participants and Methods Study Design • Transversal and longitudinal Study • Data: fromallPortuguesePublicHospitals, from 2000 to 2007.

  15. Participants and MethodsData and Variables • Variables: • Number of admissions; • Lenght of Stay; • Fatality rate: FR = Number of deaths caused by AMI Number of Admissions by AMI Extract of the database’s codes

  16. Hospitals’ Classification • According to the newest hospital classification: • Central hospitals– Including the main hospitals of the main regions in Portugal; • Distrital hospitals– Including the main hospitals of secondary regions in Portugal; • Level 1 distrital hospitals – Including the smallest hospitals.

  17. Comparison Sampleused for comparison

  18. Comparison • Bytypeof hospital • Numberofadmissions • Fatality / Survival Rates • Lengthofstay • Central hospitals • Fatality rate • Lengthofstay • Distrital hospitals • Fatality rate • Lengthofstay • Level 1 distrital hospitals • Fatality rate • Lengthofstay

  19. Comparisonbytypeof hospital Numberofadmissions Fatality rate LengthofStay

  20. Central Hospitals (N=4 719)ranking

  21. Distrital Hospitals (N=6 834)ranking

  22. Level 1 Distrital Hospitals (N=250)ranking

  23. EVOLUTION

  24. Evolution ---- Median length of stay ___ Fatality rate The evolution of fatality rates and median length of stay throughout the years, for central, distrital and level 1 distrital hospitals

  25. Discussion • EVOLUTION • Regarding the fatality rate: • No significant variation was observed for distrital and central hospitals. A slight increase was observed for type 1 distrital hospitals. • These results should not be linearly associated to a decrease in the quality of medical care provided as various factors could be related to this (ex: older population). • Regarding the length of stay: • a very slight decrease was observed, more evident between the years of 2000 and 2002 and between 2004 and 2006. • This can be connected to structural and organizational modifications in SNS hospitals, like the introduction of “Hospitais SA” in 2002 and “Hospitais EPE” in 2004.

  26. Discussion • COMPARISON • As expected, there were significant differences between the three types of hospitals. • Admittance of an association between lower fatality rate and lower length of stay. • Possible indicators in the quality of care provided.

  27. DiscussionLimitations • Information relative to the year 2007 (some changes may have occured since). • Possible information bias in the database. • No information ab0ut procedures.

  28. References • PladevalL M, Goff D C, Nichaman MZ, Chan F, Ramsey D, Ortiz C, Labarthe DR. An Assessment of the Validity of ICD Code 410 to Identify Hospital Admissions for Myocardial Infarction: The Corpus Christi Heart Project. International Journal of Epidemiology [Internet]. 1996 March [Cited 1996 Oct]; 25:948-52. Available from: http://ije.oxfordjournals.org/cgi/reprint/25/5/948 • Brahmajee KN, Wang Y, Cram P, Birkmeyer JD, Ross JS, Normand S-LT, Krumholz HM. Specialty Cardiac Hospitals Acute Myocardial Infarction and Congestive Heart Failure Outcomes. Journal Of The American Heart Association [Internet]. 2007 Oct 29 [Cited 2007 Nov 13]; 116:2280-2287. Available from: http://circ.ahajournals.org/cgi/content/full/116/20/2280 • Wang OJ, Wang Y, Lichtman JH, Bradley EH, Normand S-LT, Krumholz HM. “America’s Best Hospitals” in the Treatment of Acute Myocardial Infarction. Arch Intern Med [Internet]. 2007 Jan 3 [Cited2007 Jul 9];167(13):1345-1351. Available from: http://archinte.ama-assn.org/cgi/reprint/167/13/1345 • Younga L, Donaldc M, Parr M, Hillmana K. The Medical Emergency Team system: A two hospital Comparison. Resuscitation [Internet]. 2007 Nov 20 [Cited 2008 May]; 77:180-188. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(07)00641-7 • Madsen M, Davidsen M, Rasmussen S, Abildstrom SJ, Osler M. The validity of the diagnosis of acute myocardial infarction in routine statistics: A comparison of mortality and hospital discharge data with the Danish MONICA registry. Journal of Clinical Epidemiology [Internet]. 2002 Oct 15. [Cited 2003 Feb]; 56: 124-130. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0895435602005917 • Lutfiyya MN, Bhat DK, Gandhi SR, Nguyen C, Weidenbacher-Hoper V, Lipsky MS. A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. International Journal for Quality in Health Care [Internet]. 2007 April 18. [Cited 2007 Jun]; 19 (3): 141-149. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0895435602005917 • Tu JV, Khalid L, Donovan LR, Ko DT. Indicators of quality of care for patients with acute myocardial infarction. CMAJ [Internet]. [Cited 2008 Oct 21]; 179(9):909-915. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2565729&blobtype=pdf • Westfall JM, Kiefe CI, Weissman NW, Goudie A, Centor RM, Williams OD, Allison JJ. Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project. BMC Cardiovascular Disorders [Internet]. [Cited 2008 Sep 9]; 8: 1471-1480. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2551582&blobtype=pdf • Spertus JA, Radford MJ, Every NR, MD, Ellerbeck EF, Peterson ED, Krumholz HM. Challenges and Opportunities in Quantifying the Quality of Care for Acute Myocardial Infarction. JACC [Internet]. [Cited 2003 May 7]; 41(9): 1653-1663. Available from: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T18-48H8FH4-16-3&_cdi=4884&_user=10&_orig=search&_coverDate=05%2F07%2F2003&_sk=999589990&view=c&wchp=dGLbVlz-zSkWA&md5=c01aa03e9155ba3052b8885674bb415e&ie=/sdarticle.pdf • Spertus JA, Eagle KA, Krumholz HM, Mitchell KR, Normand S-LT. American College of Cardiology and American Heart Association Methodology for the Selection and Creation of Performance Measures for Quantifying the Quality of Cardiovascular Care. Journal Of The American Heart Association [Internet]. 2005 Jan 25 [Cited 2005 Apr 5]; 111: 1703-1712. Available from: http://circ.ahajournals.org/cgi/reprint/111/13/1703 • Romano PS, Chan BK. Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? Health Serv Res [Internet]. [Cited 2000 Mar]; 34(7): 1469–1489. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1975668&blobtype=pdf • Association AH. Acute myocardial infarction [Internet]. Greenville Avenue Dallas (TX): American Heart Association. Available from: http://www.americanheart.org/presenter.jhtml?identifier=3061532 • Costa C, Os Melhores Hospitais Doença a Doença. Sábado. 2007 Nov 8; 184(1):6-21. • Costa C, Os Melhores Hospitais Para Cada Doença. Sábado. 2008 Nov 8; 239 (2):44-58.

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