Identifying Guideline-Practice Gaps to Optimize Evaluation and Management for Patients With Syncope.
Identifying Guideline-Practice Gaps to Optimize Evaluation and Management for Patients With Syncope.
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DOI：
10.1016/j.cjca.2020.05.022
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Smyth S;Gupta V;Williams M;Cowley A;Sirrine M;Surratt H;Chadha R;Stearley S;Bhalla V;Li J
晕厥是一种常见而复杂的症状，需要有效的评估，以确定原因。最近的指导方针侧重于高价值的测试，但尚未对其执行情况进行系统的评价。为此，我们采用了调查、病历回顾和焦点小组的混合方法，以了解与晕厥患者诊断和管理相关的现行做法，并确定实施指南支持建议的障碍和促进因素。调查分发给1500提供者在医院医学，心脏病学，急诊医学和家庭医学的专业，并收到175份答复。使用临床小插图评估I类和III类指南建议的知识，这些小插图的回答正确率为60%-80%。病历审查重点关注患者病史和晕厥检测。根据指南，< 50%的图表符合最低限度病史和体格检查的标准。根据文件，根据指南，25%的超声心动图和90%的神经系统检查不合适。自我报告和实际实践模式的测试率相似。我们的研究结果表明，指南指导的管理和晕厥的实际实践之间仍然存在差距。焦点小组揭示了需要解决的多层次护理障碍，以改善护理。我们的研究结果强调需要采取积极主动的策略来改善晕厥测试实践，这可能会为医疗保健系统节省数百万美元。
Syncope is a common and complex symptom that requires efficient evaluation to determine the cause. Recent guidelines focus on high-value testing, but a systematic evaluation of their implementation has not been performed. To this end, we used a mixed-methods approach of surveys, chart reviews, and focus groups to understand current practices relating to the diagnosis and management of patients with syncope and to identify barriers and facilitators to the implementation of guideline-supported recommendations. Surveys were distributed to 1500 providers in the specialties of hospital medicine, cardiology, emergency medicine, and family medicine, and 175 responses were received. Knowledge of class I and III guideline recommendations were assessed with the use of clinical vignettes, which were answered correctly 60%−80% of the time. Chart reviews focused on patient history and testing for syncope. Per the guidelines, < 50% of charts met criteria for bare minimum history and physical examination. Based on the documentation, 25% of echocardiograms and 90% of neurologic testing obtained would not have been appropriate per the guidelines. Self-reported and actual practice patterns were similar in rates of testing. Our results indicate that there remains a gap between guideline-directed management and actual practice for syncope. Focus groups revealed barriers across multiple levels of care that need to be addressed to improve care. Our findings emphasize the need for proactive strategies to improve syncope testing practices, potentially saving millions of dollars in the health care system.
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