Are Quality Improvements in the Get With The Guidelines-Stroke Program Related to Better Care or Better Data Documentation?
Are Quality Improvements in the Get With The Guidelines-Stroke Program Related to Better Care or Better Data Documentation?
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中风指南计划的质量改进与更好的护理或更好的数据记录有关吗？
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
L. Schwamm
中科院分区：
文献类型：
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作者：
M. Reeves;Maria V. Grau‐Sepulveda;G. Fonarow;Daiwai M. Olson;Eric E. Smith;L. Schwamm
背景--提高对绩效衡量标准的遵从性可能反映出更好的护理或更好的数据记录。我们检查了符合条件、治疗禁忌症和GET与指南-卒中计划中缺失数据的文档记录的趋势，以量化它们对提高绩效衡量遵从性的贡献。方法和结果--获得了2003年4月至2009年9月1028家GWTG-卒中医院收治的569 883例缺血性卒中患者的数据。观察7项措施：静脉注射重组组织型纤溶酶原激活剂、早期抗血栓药、预防深静脉血栓形成、抗凝治疗房颤/扑动、出院抗血栓药、血脂治疗和戒烟。在每个目标人群中，已接受治疗、未接受治疗、因禁忌症而未接受治疗或数据缺失的受试者比例按历年产生。其中6项措施的目标人群规模变化很小；然而，由于数据收集形式的格式改变，2008年深静脉血栓预防人群的规模减少了≈5%。所有指标都显示，在整个研究期间，符合条件的受试者接受治疗的比例显著增加。这些增加没有发生禁忌症的重大变化或丢失数据，但心房颤动/扑动的抗凝除外，其增加与禁忌症的减少同时发生。当根据医院参与该计划的持续时间检查数据时，也看到了类似的发现。结论--这些发现表明，GET与指南-卒中计划的大部分性能改善代表了接受中风治疗的患者数量的增加，而不是潜在目标人群的变化或禁忌症或缺失数据的记录。
Background— Increased compliance with performance measures could reflect better care or better data documentation. We examined trends in the documentation of eligibility criteria, treatment contraindications, and missing data in the Get With The Guidelines-Stroke program to quantify their contribution to increased performance measure compliance. Methods and Results— Data on 569 883 ischemic stroke admissions to 1028 GWTG-Stroke hospitals between April 2003 and September 2009 were obtained. Seven measures were examined: intravenous recombinant tissue plasminogen activator therapy, early antithrombotics, deep vein thrombosis prophylaxis, anticoagulants for atrial fibrillation/flutter, discharge antithrombotics, lipid therapy, and smoking cessation. Within each target population, the proportion of subjects treated, not treated, not treated because of contraindications, or with missing data were generated by calendar year. There were minimal changes in the size of the target populations for 6 of the measures; however, the size of the deep vein thrombosis prophylaxis population was reduced ≈5% in 2008 because of a format change to the data collection form. All measures showed significant increases in the proportion of eligible subjects treated across the study period. These increases occurred without major shifts in contraindications or missing data, with the exception of anticoagulation for atrial fibrillation/flutter where the increase occurred in conjunction with a decline in contraindications. Similar findings were seen when the data were examined by the duration of hospital participation in the program. Conclusions— These findings suggest that the majority of performance improvement in the Get With The Guidelines-Stroke program represent an increase in the number of patients with stroke treated and not changes to the underlying target populations or documentation of contraindications or missing data.
患有房颤的老年人使用抗凝剂的时间趋势。
影响因子：
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作者：
Smith,NL;Psaty,BM;Furberg,CD;White,R;Lima,JA;Newman,AB;Manolio,TA
通讯作者：
Manolio,TA