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

Analysis of Medical Service and Quality Safety Report of Acute ST-Segment Elevation Myocardial Infarction(STEMI)in China

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。

Objective To 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.Methods Based 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.Results The 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.