Using IT to Improve the Quality of CVD Prevention & Management

利用信息技术提高心血管疾病预防质量

• 批准号: 7355422
• 负责人: THOMAS MICHAEL VOGT
• 金额: $ 31.57万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-05 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7355422
• 关键词: Using; Improve; Quality; CVD; Prevention

DESCRIPTION (Provided by the Applicant): Electronic medical records (EMR) offer the opportunity to analyze total medical care experience to determine what works and what does not, to identify patterns of care that are more or less effective, and to define the relative short-term and long-term costs and cost effectiveness of various approaches to care. This study will use EMRs in a large health-care system to: 1) identify practice variations in delivery of key CVD preventive and disease management services; 2) relate practice variation to morbid and mortal outcomes over 4-5 years among patients in the clinical practices, and also to variations over time in utilization and costs of medical care; and 3) provide feedback to managers on how guidelines adherence at the practice, health-care team, and system levels relates to morbid and mortal events, and to costs of care. Using the EMR, we will observe all health care utilization and diagnoses among a cohort of adult health plan members of a large integrated care system with at least two years of continuous plan membership prior to January 1, 2005. Observation will continue through mid-2008, providing 4-5 years (2003-2008) of longitudinal data on each individual. Using a person-time methodology that evaluates adherence to prevention and selected CVD management guidelines, we will describe variations at the practice level in CVD prevention and preventive management of patients with hypertension, hyperlipidemia, diabetes, congestive heart failure, and past myocardial infarction. We will relate those variations to morbidity, mortality, and health-care costs over the follow-up period. The estimated sample of 118,000 individuals should produce more than 12,000 major CVD events over the five years of follow-up. Patients without diabetes, hypertension, hyperlipidemia, and prior CVD will be examined separately for preventive services only. Those with prior CVD and related diagnoses will be examined for both preventive and management guidelines adherence. These data will clarify the relationships between evidence-based guidelines adherence and outcomes. That information will then be provided to managers in order to determine its impact on health-care processes and policies.

描述(由申请人提供)：电子病历(EMR)提供了分析整体医疗体验的机会，以确定哪些有效，哪些无效，确定或多或少有效的护理模式，并确定各种护理方法的相对短期和长期成本和成本效益。这项研究将在大型医疗保健系统中使用EMR，以：1)确定提供关键心血管疾病预防和疾病管理服务的实践差异；2)将实践差异与临床实践中患者4-5年的病死率结果，以及随时间的利用和医疗成本的变化联系起来；以及3)向管理人员提供反馈，说明实践、医疗团队和系统层面的指南遵守如何与病态和致命事件以及医疗成本相关。使用EMR，我们将观察2005年1月1日之前拥有至少两年连续计划成员的大型综合保健系统的一组成人保健计划成员的所有保健利用情况和诊断。观察将持续到2008年年中，提供每个人4-5年(2003-2008年)的纵向数据。我们将使用评估预防依从性的人员时间方法和选定的心血管疾病管理指南，描述高血压、高脂血症、糖尿病、充血性心力衰竭和既往心肌梗死患者在心血管疾病预防和预防性管理方面的实践水平的变化。我们将把这些变化与后续时期的发病率、死亡率和医疗费用联系起来。在五年的后续行动中，11.8万人的估计样本应该会产生12000多起重大心血管事件。 没有糖尿病、高血压、高脂血症和既往心血管疾病史的患者将分别接受 仅限预防性服务。那些有心血管疾病和相关诊断的患者将接受预防和管理指南的遵守情况检查。这些数据将澄清循证指南遵守和结果之间的关系。然后，这些信息将被提供给管理人员，以确定其对保健进程和政策的影响。