ASSESSING AND IMPROVING CARDIOVASCULAR DISEASE PRACTICES

描述 (改编自申请人的摘要)医疗保健系统的变化 正在改变现有的心血管疾病管理模式。 尽管它们将造成破坏，但这些力量可能会助长 将预防放在心脏位置的心血管疾病新方法 以病人为中心的临床实践。利用这些变化并不是 无可避免。目前为满足这些要求而重新设计医疗服务的机制 挑战是不够的。这项提议旨在培养一名年轻的医生 在变革管理的新科学中。通过这个奖项，兰德尔·S。 斯塔福德，医学博士，博士将以他在内科的经验为基础， 流行病学和卫生保健管理发展研究事业 致力于提高医疗质量。 拟议研究的目的是使用数据驱动的、量化的 设计、实施和评估质量改进工作的方法。它 全国数据与当地临床改善的独特配对分析 首创精神。1973-1995年全国门诊医疗保健调查数据 并对1991-94年医疗保险现行受益人调查进行分析。这 调查将重点放在心血管疾病的预防和治疗上。 多元统计分析将测试针对以下问题的研究假设： 1)目前做法的充分性，2)种族、性别、健康的作用 保险和医生专业的执业模式，以及3) 临床指南的有效性。 这些结果将直接应用于当地的质量改进 首创精神。地方项目将能够更好地确定问题的优先顺序， 直面质量实践的障碍，并确定影响的方法 医生。这项提案的研究环境将包括 合作伙伴医疗保健系统(马萨诸塞州综合医院[MGH]和 布里格姆妇女医院)。研究分析将在年内进行 麻省理工学院普通内科单位。临床改进项目将 包括：1)主动增加心房抗凝治疗的使用 纤颤，2)加强医院关键路径，以强调 预防，3)制定和使用门诊质量指标 心血管疾病实践，以及4)面向社区的评估 马萨诸塞州查尔斯敦降低缺血性心脏病风险的举措。这些 自然实验将允许对有效性进行严格的检查 质量改进的努力。最有希望的倡议将形成 可向其他医疗保健机构传播的示范系统 提高心血管护理质量。

DESCRIPTION (Adapted from the applicant's abstract) Changes in the health care system are transforming existing models of cardiovascular disease management. Despite the disruption they will cause, these forces can potentially foster a new approach to cardiovascular disease that places prevention at the heart of patient-focused clinical practice. Harnessing these changes is not inevitable. Current mechanisms for reengineering care to meet these challenges are inadequate. This proposal seeks to train a young physician in the new sciences of change management. Through this award, Randall S. Stafford, MD, PhD will build on his experience in internal medicine, epidemiology and health care management to develop a research career committed to improving the quality of health care. The aim of the proposed research is to use a data-driven, quantitative approach to design, implement and evaluate quality improvement efforts. It uniquely pairs analysis of national data with local clinical improvement initiatives. Data from the 1973-95 National Ambulatory Medical Care Surveys and the 1991-94 Medicare Current Beneficiary Surveys will be analyzed. This investigation will focus on cardiovascular disease prevention and treatment. Multivariate statistical analysis will test research hypotheses addressing: 1) the adequacy of current practices, 2) the role of race, gender, health insurance and physician specialty in practice patterns, and 3) the effectiveness of clinical guidelines. These results will be applied directly to local quality improvement initiatives. Local projects will be better able to prioritize problems, confront obstacles to quality practice, and identify methods of influencing physicians. The research environment for this proposal will encompass the Partners Health Care System (Massachusetts General Hospital [MGH] and Brigham and Women's Hospital). Research analysis will be carried out within the MGH General Internal Medicine Unit. Clinical improvement projects will include: 1) an initiative to increase the use of anticoagulation in atrial fibrillation, 2) enhancement of hospital critical pathways to emphasize prevention, 3) development and use of quality indicators for outpatient cardiovascular disease practices, and 4) evaluation of community-oriented initiatives to reduce ischemic heart disease risk in Charlestown, MA. These natural experiments will allow a rigorous examination of the effectiveness of quality improvement efforts. The most promising initiatives will form model systems that can be disseminated to other health care institutions to improve the quality of cardiovascular care.