Aboriginal and Torres Strait Islander (Indigenous) peoples with cardiac disease in Australia have worse outcomes than non-Indigenous people with cardiac disease. We hypothesised that the implementation of a culturally informed model of care for Indigenous patients hospitalised with acute coronary syndrome (ACS) would improve their clinical outcomes. For this pre-post, quasi-experimental, interventional study, cohorts of Indigenous patients before and after the implementation of a model of care were compared. The novel, culturally informed, multidisciplinary-team model of care was a local programme of care developed to reduce morbidity and mortality from cardiac conditions among Indigenous Australians. All index admissions in the 24-month pre-implementation period (Jan 1 2013, to Dec 31, 2014) were analysed, as were all index admissions in the 12-month post-implementation period (Oct 1, 2015, to Sept 30, 2016). Comparisons were also made with non-Indigenous cohorts in the same timeframes. Admissions were excluded if the patient did not survive to hospital discharge. The study was conducted at Princess Alexandra Hospital, a tertiary hospital in metropolitan Brisbane (QLD, Australia). Data on presentation, comorbidities, investigations, treatment, and for outcomes were manually collected from a consolidated clinical information application. Mortality data were obtained from the Queensland Registry of Births, Deaths, and Marriages. The primary outcome was a composite of death, acute myocardial infarction, unplanned revascularisation, and cardiac readmission at 90 days after index admission, assessed in all patients. The Indigenous cohorts included 199 patients admitted with ACS before the model of care was implemented (85 [43%] were female and 114 [57%] were male) and 119 admitted post-implementation (62 [52%] were female and 57 [48%] were male). The non-Indigenous cohorts included 440 patients with ACS before the model of care was implemented (140 [32%] were female and 300 [68%] were male) and 467 admitted post-implementation (143 [31%] were female and 324 [69%] were male). Compared with the pre-implementation group, Indigenous patients admitted post-implementation had a significant reduction in the primary outcome (67 [34%] of 199 24 [20%] of 119; hazard ratio 0·60, 95% CI 0·40–0·90; p=0·012), which was driven by a reduction in unplanned cardiac readmissions (64 [32%] of 199 21 [18%] of 119; 0·55, 0·35–0·85; p=0·0060). There was no significant change in non-Indigenous patients between the pre-implementation and post-implementation timeframes in the composite endpoint at 90 days (81 [18%] of 440 93 [20%] of 467; 1·08, 0·83–1·41; p=0·54). Pre-implementation, there was significantly more incidence of the primary outcome in Indigenous patients than non-Indigenous patients (p<0·0001), with no significant difference in the post-implementation period (p=0·92). Clinical outcomes for Indigenous patients admitted to a tertiary hospital in Australia improved after implementation of a culturally informed model of care, with a reduction in the disparity in incidence of primary endpoints that existed between Indigenous and non-Indigenous patients before implementation. Queensland Department of Health Aboriginal and Torres Strait Islander Health Division (now First Nations Health Office).

中文翻译：

---

澳大利亚三级医院的文化知情模式对患有急性冠状动脉综合征的原住民和托雷斯海峡岛民患者的护理效果：一项事前、准实验、介入研究

澳大利亚患有心脏病的原住民和托雷斯海峡岛民（原住民）的预后比患有心脏病的非原住民更差。我们假设，对因急性冠状动脉综合征（ACS）住院的土著患者实施文化知情的护理模式将改善他们的临床结果。在这项事前、准实验性、介入性研究中，对实施护理模式之前和之后的原住民患者队列进行了比较。这种新颖的、具有文化背景的多学科团队护理模式是一项当地护理计划，旨在降低澳大利亚原住民心脏病的发病率和死亡率。分析了实施前 24 个月（2013 年 1 月 1 日至 2014 年 12 月 31 日）的所有指数入场情况，以及实施后 12 个月（2015 年 10 月 1 日至 9 月 30 日）的所有指数入场情况。 2016）。还与同一时间范围内的非土著群体进行了比较。如果患者未能存活至出院，则将被排除入院。该研究是在布里斯班大都会（澳大利亚昆士兰州）的三级医院亚历山德拉公主医院进行的。有关表现、合并症、调查、治疗和结果的数据是从综合临床信息应用程序中手动收集的。死亡率数据来自昆士兰出生、死亡和婚姻登记处。主要结局是对所有患者进行评估的综合结局，包括死亡、急性心肌梗死、计划外血运重建以及入院后 90 天的心脏再入院。原住民队列包括实施护理模式前因 ACS 入院的 199 名患者（85 名 [43%] 为女性，114 名 [57%] 为男性）和实施后入院的 119 名患者（62 名 [52%] 为女性，57 名[57] 名患者）。 48%]为男性）。非土著队列包括护理模式实施前的 440 名 ACS 患者（140 名 [32%] 为女性，300 名 [68%] 为男性）和实施后入院的 467 名患者（143 名 [31%] 为女性，324 名） [69%] 为男性）。与实施前组相比，实施后入院的原住民患者的主要结局显着降低（199 名中的 67 名[34%] 119 名中的 24 名[20%]；风险比 0·60，95% CI 0·40 –0·90；p=0·012），这是由于计划外心脏再入院人数减少所致（199 名中的 64 名 [32%] 119 名中的 21 名 [18%]；0·55、0·35–0·85； p=0·0060）。在 90 天的复合终点中，非土著患者在实施前和实施后时间范围内没有显着变化（440 名中的 81 名 [18%] 467 名中的 93 名 [20%]；1·08、0·83 –1·41；p=0·54)。实施前，原住民患者主要结局的发生率显着高于非原住民患者（p<0·0001），而实施后无显着差异（p=0·92）。在实施文化知情的护理模式后，澳大利亚三级医院收治的原住民患者的临床结果得到改善，实施前原住民和非原住民患者之间存在的主要终点发生率差异有所缩小。昆士兰州卫生部原住民和托雷斯海峡岛民卫生部门（现为原住民卫生办公室）。