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JAHA:China PEACE研究对比中美心梗医疗质量:中国得80分,美国99.4分

2017-07-05 文韬 中国循环杂志

近期,JAHA发表了国家心血管病中心、阜外医院实施的China PEACE研究医疗质量评价研究结果,并与美国相应的数据进行了比较。

近期,JAHA发表了国家心血管病中心、阜外医院实施的China PEACE研究医疗质量评价研究结果,并与美国相应的数据进行了比较。

该研究主要评价了指南中的六项治疗措施,包括再灌注治疗,入院24小时内应用阿司匹林、氯吡格雷,住院期间应用β受体阻滞剂、ACE 抑制剂/ARB和他汀类药物。

研究发现,2001~2011十年间中国ST段抬高型心肌梗死(STEMI)患者医疗质量有大幅提高。2001年的有56.8%的医疗行为符合指南推荐,在2011年则上升到80.5%。

但这与美国还有很大的距离。2006年,美国符合指南推荐的比例达到94%,2011年更是达到了99.4%,几乎达到了100%。

在2011年,中国能够完全实施全部6项指标的患者仅有14%,2006年为46%,2011年为42%。表现最好的医院在2011年能有77%的患者满足6项指标。

作者也认为,虽然中国最好的医院几乎可以和美国相媲美,但绝大多数差强人意,今后的重点应针对那些表现欠佳的医院。

作者称,中国提高医疗质量也面临很多困难,比如领导力缺乏、医疗费用以及医院救治资源欠缺等。

具体而言,2001年-2011年在适宜人群中,再灌注治疗率轻度下降。均不足60%。

氯吡格雷和他汀类药物有大幅提高。院内应用β受体阻滞剂、ACE I/ARB类药物2011年反而较2006年轻度下降。



图 1 2001年、2006年、2011年STEMI诊疗指南中各项推荐干预措施中国医院实施情况

研究发现,尽管各项有效诊疗措施的比率不断提高,但是STEMI患者经危险校正的死亡率并未下降。

作者认为,医疗质量指标与患者死亡率的关系比较复杂。除这些指标外,还受急诊介入的水平、医务人员的临床能力以及医院的协调能力有关。

作者表示,中国目前拥有心肌梗死诊疗能力的医院6000余家,而该研究有全国代表性,评价了医院间STEMI医疗质量差异的研究,为提高我国医疗质量提供了坚实的数据支撑。

原始出处:

Downing NS, Wang Y, et al. Quality of Care in Chinese Hospitals: Processes and Outcomes After ST-segment Elevation Myocardial Infarction. J Am Heart Assoc. 2017 Jun 23;6(6). pii: e005040. doi: 10.1161/JAHA.116.005040.

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    2018-06-03 feather89
  2. 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    2017-10-18 drwjr
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    2017-08-07 shanyongle
  4. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Wed Jul 05 12:18:05 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-07 zhaohui6731
  5. 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  6. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 05 12:38:00 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218803, encodeId=db6d218803a8, content=说明中国心梗医疗质量有待提高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Jul 05 12:25:33 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218802, encodeId=338b2188026f, content=看起来分差不大 实际上的距离不是那么短, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Wed Jul 05 12:18:05 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-06 Dr.jerry

    谢谢

    0

  7. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 05 12:38:00 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218803, encodeId=db6d218803a8, content=说明中国心梗医疗质量有待提高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Jul 05 12:25:33 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218802, encodeId=338b2188026f, content=看起来分差不大 实际上的距离不是那么短, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Wed Jul 05 12:18:05 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 Dr.jerry

    谢谢

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1726557, encodeId=77c61e2655769, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sun Jun 03 21:49:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008116, encodeId=2f8220081165f, content=<a href='/topic/show?id=f244465139' target=_blank style='color:#2F92EE;'>#CHINA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4651, encryptionId=f244465139, topicName=CHINA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Thu Jul 06 00:55:00 CST 2017, time=2017-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218896, encodeId=fc4b218896c7, content=谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Jul 05 18:25:48 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218805, encodeId=6665218805f7, content=学习,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 05 12:38:00 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218803, encodeId=db6d218803a8, content=说明中国心梗医疗质量有待提高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Jul 05 12:25:33 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218802, encodeId=338b2188026f, content=看起来分差不大 实际上的距离不是那么短, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Wed Jul 05 12:18:05 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 执着追梦

    学习,谢谢分享

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1726557, encodeId=77c61e2655769, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sun Jun 03 21:49:00 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008116, encodeId=2f8220081165f, content=<a href='/topic/show?id=f244465139' target=_blank style='color:#2F92EE;'>#CHINA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4651, encryptionId=f244465139, topicName=CHINA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Thu Jul 06 00:55:00 CST 2017, time=2017-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218896, encodeId=fc4b218896c7, content=谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Jul 05 18:25:48 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218805, encodeId=6665218805f7, content=学习,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 05 12:38:00 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218803, encodeId=db6d218803a8, content=说明中国心梗医疗质量有待提高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Jul 05 12:25:33 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218802, encodeId=338b2188026f, content=看起来分差不大 实际上的距离不是那么短, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Wed Jul 05 12:18:05 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 邓启付

    说明中国心梗医疗质量有待提高。

    0

  10. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 05 12:38:00 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218803, encodeId=db6d218803a8, content=说明中国心梗医疗质量有待提高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Jul 05 12:25:33 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218802, encodeId=338b2188026f, content=看起来分差不大 实际上的距离不是那么短, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Wed Jul 05 12:18:05 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 雾夜芭蕾

    看起来分差不大 实际上的距离不是那么短

    0

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连续几天觉得很累,以为是值班、手术连轴转的结果,合肥市三院普外科42岁的副主任医师罗志钢没太在意,还是在6月17日下午站上了手术台,却没能站到手术结束。第二天中午,他被查出心梗,紧急送往手术室取出血栓,医生在他的心脏里放了三个支架。直到这时,他才能躺在床上好好休息休息。

SCI REP:心房颤动作为心肌梗死和心血管死亡的预后指标!

这些结果表明心房颤动是心肌梗死、心血管死亡和心血管事件的独立危险因素。

警惕!致命的咽喉痛——心梗,不容忽视!

有一种致命的咽喉痛——冠心病。而这经常是容易被漏诊的疾病,而且一旦漏诊,常常可能带来致命的威胁。

国家心血管病中心等五家机构呼吁:防心梗,有五条防线

近期,中华预防医学会健康传播分会、中华医学会心血管病分会、国家心血管病中心防治资讯部、中国疾病预防控制中心慢病中心、中国心血管健康联盟五家专业机构联合发布《“管理胆固醇,防心梗”核心提示》。

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