Improving care after myocardial infarction using a 2-year internet-delivered intervention: the Department of Veterans Affairs myocardial infarction-plus cluster-randomized trial.
Improving care after myocardial infarction using a 2-year internet-delivered intervention: the Department of Veterans Affairs myocardial infarction-plus cluster-randomized trial.
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DOI：
10.1001/archinternmed.2011.498
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发表时间：
2011-11-28
影响因子：
--
通讯作者：
Kiefe CI
中科院分区：
文献类型：
--
作者：
Levine DA;Funkhouser EM;Houston TK;Gerald JK;Johnson-Roe N;Allison JJ;Richman J;Kiefe CI
Cardiovascular risk reduction in ambulatory myocardial infarction (MI) survivors is effective but underused. To evaluate a provider-directed, Internet-delivered intervention to improve cardiovascular management for outpatients who survived MI. Cluster-randomized trial involving 168 community-based primary care clinics and 847 providers in 26 states and Puerto Rico, January 2002 to December 2008, with clinic as randomization unit. We collected administrative data for 15,847 post-MI patients and medical record data for 10,452 of these. Multi-component, Internet-delivered intervention with quarterly educational modules, practice guidelines, monthly literature summaries, and automated email reminders delivered to providers over 27 months. % patients who achieved each of 7 clinical indicators, a composite score of the 7 clinical indicators, and mean LDL and HgbA1c levels. Clinics had a median of 3 providers (interquartile range, 2–6), with a median of 50% of providers (33.3–66.7) participating in the study. Patients in intervention clinics had greater improvements (from 85.2% to 88.0%) in the percentage prescribed beta-blockers than patients in control clinics (87% to 89.1%; adjusted improvement gain for intervention versus control, 2.6%; 95% CI, 0.1%−4.1%). We found non-significant differences in improvements favoring patients in intervention clinics for 5 of 6 remaining clinical indicators and levels of LDL and HgbA1c. A longitudinal, Internet-delivered intervention improved only 1 of 7 clinical indicators of cardiovascular management in ambulatory MI survivors.
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通讯作者：
Boles, SM
影响因子：
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通讯作者：
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