[1]窦克非王虹剑韩雅玲杨跃进.全国急性ST段抬高型心肌梗死(STEMI)医疗服务与质量安全报告分析[J].中国卫生质量管理,2023,30(08):001-6.[doi:10.13912/j.cnki.chqm.2023.30.8.01 ]
　DOU Kefei,WANG Hongjian,HAN Yaling.Analysis of Medical Service and Quality Safety Report of Acute ST-Segment Elevation Myocardial Infarction (STEMI) in China[J].Chinese Health Quality Management,2023,30(08):001-6.[doi:10.13912/j.cnki.chqm.2023.30.8.01 ]
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全国急性ST段抬高型心肌梗死(STEMI)医疗服务与质量安全报告分析
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《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R]

卷:
第30卷
期数:
2023年08期
页码:
001-6
栏目:
特别关注
出版日期:
2023-08-15

文章信息/Info

Title:
Analysis of Medical Service and Quality Safety Report of Acute ST-Segment Elevation Myocardial Infarction (STEMI) in China
作者:
窦克非王虹剑韩雅玲杨跃进
国家心血管病医疗质量控制中心
Author(s):
DOU Kefei; WANG Hongjian; HAN Yaling
National Center for Cardiovascular Quality Improvement (NCCQI)
关键词:
急性ST段抬高型心肌梗死; 医疗质量; 质量评价
Keywords:
Acute ST-Segment Elevation Myocardial Infarction; Medical Quality;  Quality Evaluation
分类号:
R54
DOI:
10.13912/j.cnki.chqm.2023.30.8.01
文献标志码:
A
摘要:
目的了解我国急性ST段抬高型心肌梗死（STEMI）医疗服务与质量安全工作现状，为急性STEMI医疗质量持续改进提供参考。方法基于国家单病种质量管理与控制平台，收集并分析2019年-2020年二、三级医院急性STEMI相关数据，利用SAS 9.4软件对数据进行分析。结果2020年急性STEMI患者平均住院日二、三级医院间与地区间均有所差异；各地区住院费用相比2019年呈减少趋势（P＜0.05）。过程指标中，检查及循证药物使用情况2020年较2019年有所改善，发病12 h内到院患者再灌注治疗率总体为72.1%，其中到院90 min内进行直接PCI的比例为43.4%，在三级医院较高，溶栓患者到院30 min内溶栓治疗的比例为35.3%，二级医院高于三级医院。结局指标中，2020年住院死亡率总体为1.8%，三级医院2020年住院死亡率较2019年增加明显（P＜0.05），各地区住院死亡率存在差异。结论我国急性STEMI医疗服务质量地区间和医疗机构级别间存在差异。医疗机构应持续关注急性STEMI过程指标及结局指标，国家心血管病医疗质量控制中心应继续开展医疗质量改进行动，推动同质化发展。
Abstract:
ObjectiveTo investigate the status of medical service and quality safety of acute ST-segment elevation myocardial infarction (STEMI) in China, and provide reference for continuous improvement of medical quality of acute STEMI.MethodsBased on the Medical Quality and Safety Monitoring System, data related to acute STEMI in secondary and tertiary hospitals from 2019 to 2020 were collected and analyzed, and SAS 9.4 software was used to analyze the data.ResultsThe average length of stay of acute STEMI patients in 2020 was different between secondary and tertiary hospitals and among regions. The hospitalization expenses in all regions showed a decreasing trend compared with 2019 (P< 0.05). In terms of procedure measures indicators, the use of examinations and evidence-based drugs in 2020 was improved compared with that in 2019. The overall reperfusion treatment rate of patients admitted to hospital within 12 hours of onset was 72.1%, and the proportion of direct PCI performed within 12 hours of onset to 90 minutes of admission was 43.4%,which was higher in tertiary hospitals. The proportion of thrombolysis treatment within 12 hours of onset to 30 minutes of adminssion was 35.3%, and the proportion in secondary hospitals was higher than that in tertiary hospitals. Among the outcome measures, the overall in-hospital mortality in 2020 was 1.8%, and the in-hospital mortality in tertiary hospitals increased significantly in 2020 compared with that in 2019 (P< 0.05), there were differences among different regions.Conclusion There were regional and institutional differences in the quality of STEMI medical services in China.The procedure and outcomes measures of STEMI should continue to be a concern of medical institutions. The Working Group on Coronary Artery Disease, National Center for Cardiovascular Quality Improvement (NCCQI) will carry out quality improvement strategies to boost the homogenization development of medical quality of acute STEMI .

参考文献/References:

［1］SAWANO M, KOHSAKA S, ISHII H, et al.One-year outcome after percutaneous coronary intervention for acute coronary syndrome- an analysis of 20,042 patients from a Japanese nationwide registry［J］. Circ J, 2021. 85(10): 1756-1767. ［2］BORA N, DENNIS H, SADIA H, et al. Long term survival after acute myocardial infarction in Australia and New Zealand, 2009-2015: a population cohort study［J］. The Medical Journal of Australia, 2021，214(11): 519-525. ［3］中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南［J］. 中华心血管病杂志, 2015，43(5): 380-393. ［4］国家卫生健康委办公厅.关于印发心血管系统疾病相关专业医疗质量控制指标（2021 年版）的通知［EB/OL］. (2021-02-18) ［2021-08-24］. http://www.nhc.gov.cn/yzygj/s7657/202102/650268edd482442da 50f62954fc94f13.shtml. ［5］国家卫生健康委医政医管局.国家单病种质量管理与控制平台［EB/OL］. ［2021-08-24］.https://ncisdc.medidata.cn/login.jsp. ［6］刘倩楠, 聂 静, 张振伟,等. 单病种过程质量评价现状及思考［J］. 中国卫生质量管理, 2022, 29(7):8-11,18. ［7］2021年国家医疗质量安全改进目标［J］. 中国卫生质量管理, 2021, 28(4):15. ［8］MASOUDI FA, PONIRAKIS A, LEMOS J, et al. Executive summary:trends in u.s. cardiovascular care: 2016 report from 4 acc national cardiovascular data registries［J］. Journal of the American College of Cardiology, 2017,69(11): 1427-1450. ［9］BAGAI A, CHEN AY, UDELL JA, et al. Association of cognitive impairment with treatment and outcomes in older myocardial infarction patients: a report from the ncdr chest pain-Mi registry［J］.Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease,2019,8(17): e012929. ［10］PARTNERSHIP HQI. MINAP analyses 2011［EB/OL］. (2012-09-21) ［2020-01-19］. https://data.gov.uk/dataset/409838f7-cfb8-49c3-b83a-db0d425a887e/minapanalyses-2011. ［11］IBANEZ B, JAMES S, AGEWALL S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)［J］.Eur Heart J, 2018,39(2): 119-177. ［12］HAO Y, ZHAO D, LIU J, et al.Performance of management strategies with class irecommendations among patients hospitalized with ST-segment elevation myocardial infarction in China［J］. JAMA Cardiology, 2022,7(5): 484-491. ［13］LYTLE BL, LI S, LOFTHUS DM, et al.Targeted versus standard feedback: results from a randomized quality improvement trial［J］. American Heart Journal,2015,169(1): 132-141. ［14］KUEHNEMUND L, KOEPPE J, FELD J, et al. Gender differences in acute myocardial infarction-a nationwide german real-life analysis from 2014 to 2017［J］. Clinical Cardiology, 2021,44(7): 890-898. ［15］SZUMMER K, WALLENTIN L,LINDHAGEN L, et al. Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014［J］. European Heart Journal, 2017,38(41): 3056-3065. ［16］UDELL JA, FONAROW GC, MADDOX TM, et al. Sustained sex-based treatment differences in acute coronary syndrome care: insights from the American Heart Association Get With The Guidelines Coronary Artery Disease Registry［J］. Clin Cardiol, 2018,41(6): 758-768. ［17］SINJINI B,STEPHEN JD, JEFFREY L, et al. Australian trends in procedural characteristics and outcomes in patients undergoing percutaneous coronary intervention for ST-Elevation Myocardial Infarction［J］. Am J Cardiol, 2018,121(3): 279-288. ［18］XIANG D, XIANG X, ZHANG W, et al. Management and outcomes of patients with stemi during the COVID-19 pandemic in China［J］. Journal of the American College of Cardiology, 2020,76(11): 1318-1324. ［19］国家心血管病医疗质量控制中心.关于印发《国家心血管病医疗质量改进行动方案（2021-2023）》的通知［EB/OL］.（2021-05-20）［2023-02-12］.https://www.nccqi.org.cn/Center/News/Article/26.

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更新日期/Last Update: 2023-08-15