VALIDATING GUIDELINES FOR THE CARE OF AMI PATIENTS

急性心肌梗死（AMI）是美国的主要死亡原因， 今年至少有60万美国人将因此住院， 数百亿美元的额外医疗保健费用， 失去生产力。 许多医疗保健组织已经开发了 这些患者的护理指南。 但是，这些指导方针 尽管有任何验证表明它们可以有效地改善 患者结局或影响成本。 本提案是一项研究性研究， 将验证AMI患者血管造影的国家指南， 冠状动脉旁路移植术（CABG）或经皮腔内 血管成形术（PTCA）。 整个项目将涉及六项研究 子项目;其中五个旨在更多地了解多个 与护理过程相关的因素及其与 指导方针和随后的患者结局。 第六个目的是 编辑和分析连续队列（自1987年以来）的医疗保险数据 这样我们就可以将他们的经历与 在此期间，诊断和治疗的变化。 与HCFA和心血管合作项目合作， 小组将获得详细的病人和医院层面的数据， 概率样本的近8200名患者生活在七个州之一。 我们将使用这些数据来评估每位患者是否适合 血管造影和CABG或PTCA，并将比较 对准则的遵守影响到结果（健康和财务）。 健康结局将包括死亡率和各种功能状态 以及从患者访谈L2和36中获得的一般健康结果 AMI后3个月。适当性将由美国大学衡量。 心脏病学和美国心脏协会（ACC/AHA）和兰德指南。 将对40多名典型患者进行成本-效果分析 AMI后的报告，并将导致指南的比较 从成本效益的角度来看， 从临床的角度来看。 最后，为了了解可能的 医生不遵守国家指南的原因，我们 将调查七个州的2000多名心脏病专家， 对AMI患者使用这些手术的态度。

Acute myocardial infarction (AMI) is the leading cause of death in the US, and this year at least 600,000 Americans will be hospitalized for it at a cost of tens of billions of dollars in additional health care costs and lost productivity. Numerous health care organizations have developed guidelines for the care of these patients. But, these guidelines have been promulgated despite any validation that they can effectively improve patient outcomes or affect costs. This proposal is a research study that will validate national guidelines for AMI patients for angiography, coronary artery bypass graft (CABG) or percutaneous transluminal angioplasty (PTCA). The entire project will involve six research subprojects; five of these are designed to learn more about the multiple factors associated with processes of care and their relationship to guidelines and subsequent patient outcomes. The sixth is designed to compile and analyze data on successive cohorts (since 1987) of Medicare patients who have an AMI so that we can correlate their experiences with the introduction of changes in diagnosis and treatment during this period. In collaboration with HCFA and the Cooperative Cardiovascular Project the group will obtain detailed patient and hospital level data on a probability sample of nearly 8200 patients living in one of seven states. We will use these data to evaluate each patient's appropriateness for angiography and CABG or PTCA and will compare the extent to which adherence to guidelines affects outcomes (both health and financial). Health outcomes will include mortality and a variety of functional status and general health outcomes obtained from patient interviews l2 and 36 months post AMI. Appropriateness will be measured by American College of Cardiology and American Heart Association (ACC/AHA) and RAND guidelines. Cost-effectiveness analyses will be performed for over 40 typical patient presentations after an AMI and will lead to a comparison of guidelines created from a cost-effectiveness perspective with those created primarily from a clinical perspective. Finally, in order to understand possible reasons for non-adherence to the national guidelines by physicians, we will survey over 2000 cardiologists in seven states to understand their attitudes towards the use of these procedures in AMI patients.