A qualitative study of increasing β-blocker use after myocardial infarction -: Why do some hospitals succeed?
A qualitative study of increasing β-blocker use after myocardial infarction -: Why do some hospitals succeed?
复制标题
DOI：
10.1001/jama.285.20.2604
复制
发表时间：
2001-05-23
影响因子：
120.7
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Bradley, EH;Holmboe, ES;Krumholz, HM
背景基于β-受体阻滞剂可以降低急性心肌梗死（AMI）患者死亡率的证据，许多医院已经开始努力提高性能，以增加出院时β-受体阻滞剂的处方，确定与这种改善相关的因素可以为在增加β-受体阻滞剂使用方面不太成功的医院提供指导，目的确定可能影响AMI后增加β受体阻滞剂使用的改善措施成功的因素，并建立一个分类法对这些措施进行分类。和参与者定性研究，其中数据收集从2000年3月至6月进行的深入访谈与45名关键医生，护理，质量管理，选择8家美国医院的管理参与者，代表一系列医院规模、地理区域以及1996年10月至1999年9月期间β受体阻滞剂使用率的变化。主要结果衡量举措、策略，结果访谈揭示了6个主要因素，以医院为基础的改善工作的特点：努力的目标，行政支持，临床医生之间的支持，改进计划的设计和实施，数据的使用和修改变量。随着时间的推移，β受体阻滞剂使用改善程度更大的医院表现出4个在改善程度较低或无改善的医院中没有发现的特征：共同的改进目标，大量的行政支持，强有力的医生领导倡导使用β受体阻滞剂，并使用可靠的数据反馈，结论本研究通过描述一种分类法，评估这些努力。此外，该研究还提出了增加急性心肌梗死患者β受体阻滞剂使用的可能成功因素。
Context Based on evidence that beta -blockers can reduce mortality in patients with acute myocardial infarction (AMI), many hospitals have initiated performance improvement efforts to increase prescription of beta -blockers at discharge, Determination of the factors associated with such improvements may provide guidance to hospitals that have been less successful in increasing beta -blocker use,Objectives To identify factors that may influence the success of improvement efforts to increase beta -blocker use after AMI and to develop a taxonomy for classifying such efforts.Design, Setting, and Participants Qualitative study in which data were gathered from in-depth interviews conducted in March-June 2000 with 45 key physician, nursing, quality management, and administrative participants at 8 US hospitals chosen to represent a range of hospital sizes, geographic regions, and changes in beta -blocker use rates between October 1996 and September 1999.Main Outcome Measures initiatives, strategies, and approaches to improve care for patients with AMI.Results The interviews revealed 6 broad factors that characterized hospital-based improvement efforts: goals of the efforts, administrative support, support among clinicians, design and implementation of improvement initiatives, use of data, and modifying variables. Hospitals with greater improvements in beta -blocker use over time demonstrated 4 characteristics not found in hospitals with less or no improvement: shared goals for improvement, substantial administrative support, strong physician leadership advocating beta -blocker use, and use of credible data feedback,Conclusions This study provides a context for understanding efforts to improve care in the hospital setting by describing a taxonomy for classifying and evaluating such efforts. In addition, the study suggests possible elements of successful efforts to increase beta -blocker use for patients with AMI.