Background

Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Système national des données de santé; SNDS) can be used to compare these guidelines with real-life practice.

Aims

To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization.

Methods

We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients.

Results

Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%).

Conclusions

Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.

中文翻译：

---

在法国因心力衰竭住院前后30天的门诊医疗利用率：国家医疗数据库（Systèmenationaldesdonnéesdesanté）的贡献。

背景

已经发布了有关因心力衰竭住院治疗的患者管理指南。法国国家医疗数据库（Systeme的 国家 宫 最近搜索 去 桑特; SNDS）可以用来比较现实生活中实践这些原则。

目的

研究住院前后30天因心力衰竭的医疗保健利用情况，以及因住院病人较少而无法入院的住院病人所引起的变化。

方法

我们确定了2015年健康保险计划的成年受益人首次因心力衰竭住院，该保险覆盖了88％的法国人口，他们在住院30天后还活着。描述了所有患者以及不包括住院患者的亚组的住院后30天内的门诊医疗利用率，门诊服务的中位时间及其四分位数间距。

结果

在104,984名患者中（平均年龄79岁；女性52％），其中74％为非住院治疗（平均年龄78岁；女性47％）。住院后至少进行一次咨询的频率和咨询的中位数时间分别为69％（总样本）与78％（不包括住院患者的亚组）和8天（四分位间距3; 16）与7天（3; 15） ），对于普通科医生而言，心脏病专家占20％vs. 21％and 14天（7; 23）vs. 16天（9; 24），而58％vs. 69％and 3 days（1; 9）vs. 2天（ 1; 7）对于护士，利尿剂的报销比例分别为77％和86％，血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂的比例分别为48％和55％，β受体阻滞剂分别为55％和63％。除住院患者外，部门差异很大：全科诊治（四分位间距为74％； 83％），

结论

门诊医疗利用率低，首次使用医疗的间隔时间长以及部门变动表明指南与实际操作之间不匹配，当包括住院患者时，这种情况会加剧。