RIGHT HEART CATHETERIZATION: OUTCOMES AND EFFECTIVENESS

1993年，右心导管插入术（RHC）进行了120万次 美国重症患者的治疗费用超过24亿 美元. 然而，尚未确定RHC是否改善了 重症患者的生存或促进长期康复， 严重的疾病。 事实上，没有确凿的证据表明， 该手术的大多数适应症， 正确使用这项技术。 因此，RHC的使用 主要是医生和医院。 对于执业临床医生 为了适当地起诉RHC，他们需要澄清其整体 有效性和识别更有可能 从手术中获益或受到伤害 一个多学科研究小组将使用三个大型数据库， 确定：1）RHC在生存、功能 状态、生活质量和对护理的满意度; 2）使用中的变化 RHC在重症患者中的作用;以及3）RHC与 资源在危重病中的应用。 为了做到这一点， 将使用观察数据库，其中1）旨在允许 根据疾病严重程度、诊断、急性生理学和其他因素进行调整 重要的患者特征，2）证明大型医院间 RHC使用的差异，30个代表了两个关键 一般的病人和目前使用的RHC。 三 数据库包括：1）克利夫兰健康质量选择项目（CHQCP） 数据库[35，000例患者/年，30岁时来自40个ICU的所有ICU入院患者 大克利夫兰地区的医院]; 2）APACHE III数据库 [17来自全国40家医院（42个ICU）的440名患者]; 3)支助数据库[5家医院的9 105名重病患者 15个ICU）。 RHC的有效性将根据以下方面进行评估： 生存率、功能状态、生活质量和患者满意度。 为了调整选择偏倚，将对进行RHC的决策进行建模 使用影响临床医生决定的所有协变量， 执行RHC或感兴趣的结果。 将评估有效性 通过确定RHC和患者结局之间的关系， 调整进行RHC的倾向。 RHC使用的变化 医院和单位之间将被描述和检查。 协会 RHC之间，住院时间和护理强度将进行检查 在所有三个数据库中。 支持数据库将用于探索 RHC和护理成本估计之间的关系。 目前项目的成果将直接关系到健康 政策制定者，购买者，医疗保健的购买者，医生 和他们的病人谁寻求指导，在有效使用RHC，并 希望改进这种常见药物使用适应症的研究者 昂贵的技术。 关于RHC或者是 明确适当的将降低进行对照试验的障碍， RHC临床适应症似乎不明确的人群。

In 1993, right heart catheterization (RHC) was performed 1.2 million times in critically ill patients in the U.S. at a cost exceeding 2.4 billion dollars. It has not been determined, however, whether RHC improves the survival of critically ill patients or enhances long-term recovery from a serious illness. In fact, there is no conclusive evidence of benefit for most indications for this procedure and no clear guidelines for the appropriate use of this technology. Consequently, the use of RHC varies substantially among physicians and hospitals. For practicing clinicians to sue RHC appropriately, they need clarification of its overall effectiveness and identification of patients subgroups who are more likely to either benefit from or be harmed by the procedure. A multidisciplinary research team will use three large databases to determine the: 1) effectiveness of RHC in terms of survival, functional status, quality of life, and satisfaction with care; 2) variation in use of RHC in seriously ill patients; and 3) association of RHC and utilization of resources in the critically ill. To do this, three large observational databases will be used which 1) are designed to allow adjustment for severity of illness, diagnosis, acute physiology and other important patient characteristics, 2) demonstrate large interhospital differences in use of RHC, and 30 are representative of both critically ill patients in general and of the current use of RHC. The three databases include: 1) the Cleveland Health Quality Choice Project (CHQCP) database [35,000 patients/yr, all ICU admission from 40 ICUs at 30 hospitals in the Greater Cleveland area]; 2) the APACHE III database [17,440 patients from a national sample of 40 hospitals with 42 ICUs]; and 3) the SUPPORT database [9,105 seriously ill patients from 5 hospitals with 15 ICUs]. Effectiveness of RHC will be assessed with respect to survival, functional status, quality of life, and patient satisfaction. To adjust for selection bias, the decision to perform RHC will be modeled using all covariates that either influence the clinician's decision to perform RHC or the outcomes of interest. Effectiveness will be estimated by determining the relationship between RHC and patient outcomes after adjusting for the propensity to perform RHC. Variation in the use of RHC among hospitals and units will be described and examined. The association between RHC, length of stay and intensity of nursing care will be examined in all three databases. The SUPPORT database will be used to explore the relationship between RHC and estimates of the cost of care. The results of the current project will be of direct relevance to health policymakers, to purchasers, to purchasers of medical care, to physicians and their patients who seek guidance in the effective use of RHC, and to investigators who wish to refine the indications for use of this common and expensive technology. Evidence about settings in which RHC either is clearly appropriate will lower barriers to performing controlled trials in populations for which clinical indications for RHC appear equivocal.