Quality Enhancement Research Initiative in ischemic heart disease: a quality initiative from the Department of Veterans Affairs. QUERI IHD Executive Committee.
Quality Enhancement Research Initiative in ischemic heart disease: a quality initiative from the Department of Veterans Affairs. QUERI IHD Executive Committee.
复制标题
缺血性心脏病质量增强研究计划：退伍军人事务部的一项质量计划。
作者：
N. Every;S. Fihn;A. Sales;A. Keane;Ritchie
尽管缺血性心脏病（IHD）死亡率在过去30年中大幅下降，但它仍然是美国的头号死因，也是美国退伍军人事务部最常见的治疗适应症之一。国家实践指南已经由专门从事心脏病学的协会和退伍军人健康管理局制定和传播。尽管做出了这些努力，但仍有相当一部分IHD患者未接受指南推荐的治疗。IHD的质量增强研究倡议是退伍军人健康管理局发起的一项倡议，旨在解决指南推荐的治疗方法与退伍军人事务部实际做法之间的差距。由于IHD患者的指南开发相对成熟，IHD的质量增强研究计划将专注于测量现有的实践，实施干预措施，并评估IHD退伍军人的结果。现有做法的测量将通过分析现有的退伍军人事务部的数据库开发的心脏外科手术计划的持续改进，以及在急性心肌梗死退伍军人的实践模式研究中心收集的数据进行评估。为了衡量IHD门诊患者的现有做法，我们计划开发一个新的数据库，从患者实验室和药房记录中提取电子数据到关系数据库中。将在各个医疗中心征求和实施干预措施，以解决指南建议和实际实践之间的差距。我们计划强调即时电子提醒和在线决策支持，作为提高指南依从性的方法。
Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated both by societies that specialize in cardiology and within the Veterans Health Administration. Despite these efforts, a substantial minority remains of patients with IHD who are not treated with guideline-recommended therapies. The Quality Enhancement Research Initiative in IHD is a Veterans Health Administration-sponsored initiative to address the gap between guideline-recommended therapies and actual Department of Veterans Affairs practice. Because guideline development for patients with IHD is relatively mature, the Quality Enhancement Research Initiative in IHD will concentrate on measuring existing practices, implementing interventions, and evaluating outcomes in veterans with IHD. Measurement of existing practices will be evaluated through analyses of existing Veterans Affairs databases developed for the Continuous Improvement in Cardiac Surgery Program, as well as data collected at the Center for the Study of Practice Patterns in veterans with acute myocardial infarction. To measure existing practices in outpatients with IHD, we plan to develop a new database that extracts electronic data from patient laboratory and pharmacy records into a relational database. Interventions to address gaps between guideline recommendations and actual practice will be solicited and implemented at individual medical centers. We plan to emphasize point-of-care electronic reminders as well as online decision support as methods for improving guideline compliance.