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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. - PowerPoint PPT Presentation
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Introdução à Medicina IClass 11Adviser: Dr. Armando Teixeira Pinto
Faculdade de Medicina da Universidade do PortoCurso de Mestrado Integrado em Medicina
2008/2009
Faculdade de Medicina da Universidade do Porto
Comparison and Evolution of Medical Care of Inpatients
with Acute Myocardial Infarction in Portuguese Public
Hospitals
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.
Introduction Background and Justification
Value
Understanding the general quality concerning the treatment of AMI in Portuguese Public Hospitals.
It may create the need for improvement.
Stimulating further analysis and future studies.
Providing a guide for general population.
Age-standardised death rates per 100,000 population from AMI, from 1972 to 2002, in Portugal
020406080
100120140160180200
1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Years
Num
ber o
f Dea
ths
Acute Myocardial Infarction (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).
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. Evaluate the improvements of medical care in
hospitals.
Participants and MethodsSample
SampleAge and gender
65,3 %
34,7%
Median: 70,00
SampleGeographic distribution
2001Relative frequency of admissions
distributionFatality rate distribution
Distrito % (internments in total population)
Aveiro 0,074
Braga 0,074
Viseu 0,082
Leiria 0,085
Coimbra 0,089
Guarda 0,089
Vila Real 0,090
Porto 0,099
Santarém 0,099
Faro 0,101
Setúbal 0,104
Castelo Branco 0,110
Viana do Castelo 0,111
Portalegre 0,120
Lisboa 0,133
Bragança 0,136
Évora 0,143
Beja 0,144
Distrito %(fatalities in total population)
Viana do Castelo 0,006
Aveiro 0,007
Braga 0,008
Coimbra 0,008
Leiria 0,010
Viseu 0,010
Porto 0,011
Faro 0,013
Setúbal 0,013
Vila Real 0,013
Beja 0,014
Santarém 0,014
Guarda 0,016
Bragança 0,017
Évora 0,019
Castelo Branco 0,020
Lisboa 0,022
Portalegre 0,025
SampleGeographic distribution
2007Relative frequency of admissions
distributionFatality rate distribution
Distrito % (internments in total population)
Vila Real 0,080
Braga 0,084
Aveiro 0,090
Viseu 0,093
Leiria 0,099
Santarém 0,109
Lisboa 0,112
Porto 0,114
Viana do Castelo 0,121
Guarda 0,125
Coimbra 0,133
Setúbal 0,139
Faro 0,140
Bragança 0,165
Castelo Branco 0,167
Portalegre 0,168
Évora 0,172
Beja 0,173
Distrito % (fatalities in total population)
Vila Real 0,006
Braga 0,007
Leiria 0,009
Porto 0,009
Aveiro 0,010
Beja 0,010
Évora 0,012
Coimbra 0,013
Santarém 0,013
Viseu 0,013
Viana do Castelo 0,014
Guarda 0,015
Faro 0,016
Lisboa 0,016
Portalegre 0,018
Setúbal 0,018
Bragança 0,021
Castelo Branco 0,029
SampleEvolution
Total number of admissions with AMI, fatality rate and median length of stay in the hospital, per year of admission
(total n= 91133)
Sample
Median: 7 days
Length of Stay Fatality/Survival rate
Fatalities Survivals12,5 87,5
Participants and Methods Study Design
Transversal and longitudinal Study
Data: from all Portuguese Public Hospitals, from 2000 to 2007.Data UsedComparis
on 2007
Evolution 2000-2007
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
Participants and MethodsData and Variables
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.
ComparisonSample used for comparison
Comparison
By type of hospital
Number of admissions
Fatality / Survival Rates
Length of stay
Central hospitals Fatality rate Length of stay
Distrital hospitals Fatality rate Length of stay
Level 1 distrital hospitals Fatality rate Length of stay
Comparisonby type of hospital
Distribution according to hospital typeFrequency %
Central hospitals 4719 40,0
Distrital hospitals 6834 57,9
Level 1 distrital hospitals 250 2,1
Fatality rateFatality and survival rates
Frequency %
Central hospitalsFatalities 516 10,9Survival 4203 89,1
Distrital hospitalsFatalities 766 11,2Survival 6068 88,8
Level 1 distrital hospitals
Fatalities 47 18,8Survival 203 81,2
Length of Stay
Number of admissions
Length of stay distribution (days)Median Min Max
Central hospitals 6,00 0 203
Distrital hospitals 7,00 0 119
Level 1 distrital hospitals 7,00 0 71
Total 7,00 0 203
Central Hospitals (N=4 719)ranking
Top 5 hospitals with lowest fatality rate
Hospital code
Number of admissions
Fatality
N (%)
1 20 758 47 6,2
2 26 431 31 7,2
3 74 423 32 7,6
4 7 505 47 9,3
5 90 408 40 9,8
Bottom 5 hospitals with highest fatality rate
Hospital code
Number of admissions
Fatality
N (%)
9 25 281 36 12,8
10 45 144 21 14,6
11 16 441 73 16,6
12 50 309 58 18,8
13 32 65 19 29,2
Top 5 hospitals with lowest length of stay
Hospital code Number of admissions
Length of stay (days)
Median Percentile 25
Percentile 75
1 50 309 4 3 7
2 45 144 4 0 11
3 7 505 5 3 7
4 96 342 5 4 8
5 74 423 6 4 9
Bottom 5 hospitals with highest length of stay
Hospital code Number of admissions
Length of stay (days)
Median Percentile 25
Percentile 75
9 90 408 6 4 9
10 32 65 7 2 16
11 25 281 7 4 13
12 20 758 7 5 12
13 87 97 7 5 12
Distrital Hospitals (N=6 834)ranking
Top 5 hospitals with lowest fatality rate
Hospital code
Number of admissions
Fatality
N (%)
1 79 54 2 3,7
2 55 234 11 4,7
3 67 255 15 5,9
4 71 68 4 5,9
5 77 232 14 6,0
Bottom 5 hospitals with highest fatality rate
Hospital code
Number of admissions
Fatality
N (%)
32 19 125 23 18,4
33 37 73 14 19,2
34 4 14 3 21,4
35 56 13 3 23,1
36 31 141 42 29,8
Top 5 hospitals with lowest length of stay
Hospital code Number of admissions
Length of stay (days)
Median Percentile 25
Percentile 75
1 81 114 2 0 11
2 8 504 4 3 6
3 92 192 5 2 9
4 36 433 5 4 10
5 77 232 6 4 9
Bottom 5 hospitals with highest length of stay
Hospital code Number of admissions
Length of stay (days)
Median Percentile 25
Percentile 75
32 75 59 9 5 14
33 37 73 10 6 14
34 31 141 11 5 17
35 44 187 12 7 16
36 79 54 12 7 18
Level 1 Distrital Hospitals (N=250)ranking
Top 5 hospitals with lowest fatality rate
Hospital code
Number of admissions
Fatality
N (%)
1 47 61 4 6,6
2 58 27 3 11,1
3 29 96 19 19,8
4 3 12 3 25
5 82 23 8 34,8
Top 5 hospitals with lowest length of stay
Hospital code
Number of admissions
Length of stay (days)
Median Percentile 25 Percentile 75
1 3 12 4 1 12
2 82 23 5 2 11
3 58 27 6 5 9
4 29 96 8 4 13
5 47 61 8 6 11
EVOLUTION
020406080
100120140160180200
1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Years
Num
ber o
f Dea
ths
Evolution
The evolution of fatality rates and median length of stay throughout the years, for central, distrital and level 1 distrital hospitals
---- Median length of stay___ Fatality rate
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.
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.
DiscussionLimitations
Information relative to the year 2007 (some changes may have occured since).
Possible information bias in the database.
No information ab0ut procedures.
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