QUALITY OF CARE FOR MEDICARE PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - A 4-STATE PILOT-STUDY FROM THE COOPERATIVE CARDIOVASCULAR PROJECT
QUALITY OF CARE FOR MEDICARE PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - A 4-STATE PILOT-STUDY FROM THE COOPERATIVE CARDIOVASCULAR PROJECT
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DOI：
10.1001/jama.273.19.1509
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发表时间：
1995-05-17
影响因子：
120.7
通讯作者：
VOGEL, RA
中科院分区：
文献类型：
--
作者：
ELLERBECK, EF;JENCKS, SF;VOGEL, RA
目的.-制定和测试急性心肌梗塞 (AMI) 患者护理质量的指标。设计.-回顾性病历审查。设置.-阿拉巴马州、康涅狄格州、爱荷华州和威斯康星州的所有急症护理医院。患者.-确定 1992 年 6 月 1 日至 1993 年 2 月 28 日期间因 AMI 主要诊断而出院的 Medicare 患者的所有住院情况（N = 16） 869).主要结果测量。-接受适当干预措施的患者百分比，该干预措施由来自临床实践指南的 11 项护理质量指标定义，这些指南是在与全国医生和其他医疗保健专业人员协商后修改和更新的。结果--我们从 16 124 例 (96%) 住院患者中提取数据，代表 14 108 例初次住院和 2016 年因转院而住院。 AMI 护理中可能排除使用标准治疗的情况很常见，分别有 90% 和 70% 的患者可能排除溶栓剂和 β 受体阻滞剂。在特定干预措施的“理想候选人”队列中，83% 的人在初次住院期间接受了阿司匹林，69% 的人接受了溶栓药物，70% 的人接受了肝素； 77% 的患者在出院时接受了阿司匹林治疗，45% 的患者接受了 β 受体阻滞剂治疗。结论：这些数据表明，许多 Medicare 患者可能不是标准 AMI 治疗的理想候选者，但这些治疗方法并未得到充分利用，即使没有明显的禁忌症。将这些质量指标应用于实践的医院和医生可能会找到改进的机会。
Objective.-To develop and test indicators of the quality of care for patients with acute myocardial infarction (AMI).Design.-Retrospective medical record review.Setting.-All acute care hospitals in Alabama, Connecticut, Iowa, and Wisconsin.Patients.-All hospitalizations for Medicare patients discharged with a principal diagnosis of AMI between June 1, 1992, and February 28, 1993, were identified (N=16 869).Main Outcome Measure.-Percentage of patients receiving appropriate interventions as defined by 11 quality-of-care indicators derived from clinical practice guidelines that were modified and updated in consultation with a national group of physicians and other health care professionals.Results.-We abstracted data from 16 124 (96%) of the hospitalizations, representing 14 108 primary hospitalizations and 2016 hospitalizations resulting from transfers. Potential exclusions to the use of standard treatments in AMI care were common with 90% and 70% of patients having potential exclusions for thrombolytics and beta-blockers, respectively. In cohorts of ''ideal candidates'' for specific interventions, 83% received aspirin, 69% received thrombolytics, and 70% received heparin during the initial hospitalization; 77% received aspirin and 45% received beta-blockers at discharge.Conclusions.-These data demonstrate that many Medicare patients may not be ideal candidates for standard AMI therapies, but these treatments are underused, even in the absence of discernible contraindications. Hospitals and physicians who apply these quality indicators to their practices are likely to find opportunities for improvement.