Research Project - KlinReg
Geographic variation in healthcare utilization and medical practice in acute myocardial infarction
In Norway, approximately 13,000 heart attacks are treated annually across 53 hospitals. There are gender differences in the incidence of heart attacks. Almost two-thirds of the patients are men. The median age at acute heart attack is 69 years for men and 78 years for women. Age-adjusted incidence rates vary geographically and are highest in the northernmost counties. Age-adjusted survival after 30 days is 94% following hospitalization for acute heart attack, but many patients experience significant impairment in mental and physical function and reduced health after the attack. Therefore, good quality of care before admission, during the hospital stay, and after discharge is important.
About the Project
Internationally, many studies have been conducted on variation in practice and use of
health services for acute myocardial infarction. However, few studies contribute explanations for the observed variation, and many studies lack national coverage. There are also few studies examining the consequences of variation. To the extent that this is done, mortality is the measured outcome. Despite some variation in results for the selected quality indicators in the registries, the mortality rate within 30 days after acute myocardial infarction is overall low in Norway compared to other countries. However, some variation in 30-day mortality after acute myocardial infarction has been shown among patients residing in different catchment areas in Northern Norway.
Some variation in the quality of treatment offered at different hospitals is reported. For some indicators, the quality of treatment provided to patients residing in the various health trusts' catchment areas has also been examined, thus assessing whether the health trusts' "duty of care" is upheld. A number of national quality indicators have been introduced, as well as several management indicators for measuring unjustified variation in myocardial infarction. In this project, we will delve deeper into the causes of geographical variation in acute treatment and rehabilitation. We will investigate the justification and consequences of varying health service use, medical practice, and treatment quality.
Project Purpose
The main purpose of this PhD project is to generate knowledge about the extent of and possible explanations for geographical and other unjustified variation in health service use and medical practice in the treatment of acute myocardial infarction in Norway. This includes studying which factors at the patient level, family level, and municipal and health trust level may contribute to explaining any geographical variations. Additionally, we will examine whether geographical variation in the acute phase is associated with geographical variation in the use of health care and welfare services later in the process.
The project seeks to illuminate the following topics:
Project Research Questions
- Geographical variation in revascularization within the recommended time for STEMI – extent and explanations
- Geographical variation in follow-up after acute myocardial infarction – extent and explanations
- Paper I: Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study
- Paper II: The relation between delayed reperfusion treatment and reduced left ventricular ejection fraction in patients with ST-segment elevation myocardial infarction: a national prospective cohort study
Project participants
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Eva Stensland
Project Manager
Director SKDE, research responsible
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Bård Uleberg
PhD fellow