期刊
MEDICAL CARE
卷 50, 期 2, 页码 124-130出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0b013e31822d5d17
关键词
cardiopulmonary resuscitation; heart arrest; resuscitation
类别
资金
- Robert Wood Johnson Foundation at the University of Pennsylvania
- Institute for Health Technology Studies (Washington, DC) from the National Heart, Lung, and Blood Institute [1-R01-HL086919]
- Pennsylvania Department of Health
- Department of Veterans Affairs' Health Services Research and Development Service
- Philips Healthcare, Seattle, WA
- Laerdal Medical, Stavanger, Norway
- NIH, Bethesda, MD
- Cardiac Science, Bothell, Washington
- Laerdal Foundation for Acute Care Medicine, Stavanger, Norway
- AHRQ, Bethesda, MD
- Resuscitation Outcomes Consortium [NIH U01 HL077863-05]
- NHLBI [R21 HL093641-01A1, R01 HL089554-03]
- Resynchronization/Defibrillation for Advanced Heart Failure Trial (RAFT) [200211UCT-110607, 1RC2HL101759-01]
- Medtronic Foundation
- Laerdal Medical Corp, Stavanger, Norway
Background: It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Objectives: Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Research Design: Get with the Guidelines Resuscitation (GWTG-R) (n = 433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Participants: Adult patients with IHCA. Measures: Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. Results: We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P = 0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P = 0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P < 0.0001). Conclusions: Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.
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