循環器内科医による診療を受けた患者と非循環器内科医による診療を受けた患者との間の心臓病の入院転帰。プロペンシティスコアをマッチさせた研究

Hospitalization outcome of heart diseases between patients who received medical care by cardiologists and non-cardiologist physicians: A propensity-score matched study.

• Yu-Ming Wu
• Chih-Chung Liu
• Chun-Chieh Yeh
• Li-Chin Sung
• Chao-Shun Lin
• Yih-Giun Cherng
• Ta-Liang Chen
• Chien-Chang Liao

抄録

背景と目的:

心臓病の転帰に対する医師の専門性の影響は，いくつかの先行研究で一貫性のない知見が得られているため，まだ不完全に理解されていない。我々の目的は，循環器内科医によるケアを受けている患者と非循環器内科医（NC）によるケアを受けている患者の心臓病の入院転帰を比較することである．

BACKGROUND AND AIMS: The effects of physician specialty on the outcome of heart disease remains incompletely understood because of inconsistent findings from some previous studies. Our purpose is to compare the admission outcomes of heart disease in patients receiving care by cardiologists and noncardiologist (NC) physicians.

方法:

2008年から2013年までの台湾の国民健康保険の診療報酬請求データを用いて、心臓病で入院中に循環器内科医の治療を受けた20歳以上の患者6264人を対象としたマッチング研究を実施した。社会人口統計学的特徴、病状、および心臓病の種類を調整したプロペンシティスコアマッチング手順を用いて、NC医師の治療を受けた6264人の対照者を選択した。ロジスティック回帰を用いて、循環器内科医の治療に関連した心臓病の入院中の合併症および死亡率のオッズ比（OR）と95％信頼区間（CI）を算出した。

METHODS: Using reimbursement claims data of Taiwan's National Health Insurance from 2008-2013, we conducted a matched study of 6264 patients aged ≥20 years who received a cardiologist's care during admission for heart disease. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, and type of heart disease, 6264 controls who received an NC physician's care were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for complications and mortality during admission for heart disease associated with a cardiologist's care.

結果:

循環器内科医のケアを受けた患者は、NC医師のケアを受けた患者に比べて、肺炎（OR = 0.61；95％CI、0.53-0.70）、敗血症（OR = 0.49；95％CI、0.39-0.61）、尿路感染症（OR = 0.76；95％CI、0.66-0.88）、および院内死亡（OR = 0.37；95％CI、0.29-0.47）のリスクが低かった。循環器内科医のケアと入院後の有害事象の減少との関連は、両性および40歳以上の患者で有意であった。

RESULTS: Patients who received a cardiologist's care had a lower risk of pneumonia (OR = 0.61; 95% CI, 0.53-0.70), septicemia (OR = 0.49; 95% CI, 0.39-0.61), urinary tract infection (OR = 0.76; 95% CI, 0.66-0.88), and in-hospital mortality (OR = 0.37; 95% CI, 0.29-0.47) than did patients who received an NC physician's care. The association between a cardiologist's care and reduced adverse events following admission was significant in both sexes and in patients aged ≥40 years.

結論:

心臓病が原因で入院した患者の感染症合併症や死亡率の減少と循環器内科医の診療が関連している可能性を提起した。

CONCLUSION: We raised the possibility that cardiologist care was associated with reduced infectious complications and mortality among patients who were admitted due to heart disease.