NURSE CASE MANAGEMENT SYSTEM FOR LIPID MANAGEMENT AFTER CORONARY BYPASS SURGERY

本研究的目的是评估护士管理的个体化生活方式改变和药物干预系统对冠状动脉搭桥手术（CABG）后成人血脂紊乱的控制效果。临床试验提供了强有力的科学证据，表明降低血清胆固醇可以降低冠心病（冠心病）患者的发病率和死亡率。1尽管降胆固醇治疗有明显的益处，但许多有临床证据的动脉粥样硬化患者并没有得到有效治疗。2-4保健服务的变化，包括冠状动脉事件前后的护理，要求我们考虑更有效和经济的策略来管理冠心病患者的脂质紊乱，以便在临床药物试验之外实现降脂的益处。本研究的主要目的是：1。比较护士管理的脂质修饰项目与常规医疗护理在实现低密度脂蛋白胆固醇< 100 mg/dL或低密度脂蛋白胆固醇降低20%的目标方面的有效性。2. 确定目标实现的生理、行为和人口预测因素；3. 确定护士管理的降脂计划的成本效益；和4。评估降脂治疗对患者生活质量的影响。我们的目标是优化生活方式的改变，从而减少和提高药物干预的效果。我们假设，与那些从他们的主要提供者那里接受常规护理的人相比，参加护士管理的脂质修饰计划的人达到降低脂质目标的比例要高得多。此外，我们建议干预是一种具有成本效益的提供降脂治疗的模式，可以广泛应用。

The purpose of this study is to evaluate the effectiveness of a nurse-managed, case-management system of individualized lifestyle modification and pharmacologic intervention to manage lipid disorders in adults who have undergone coronary artery bypass graft surgery (CABG). Clinical trials have provided strong scientific evidence that lowering serum cholesterol will reduce morbidity and mortality from coronary heart disease (CHD) in patients with established CHD.1 Despite the clear benefits of cholesterol-lowering treatment, many patients with clinical evidence of atherosclerosis are not being treated effectively.2-4 Changes in the delivery of health care, including care for and after coronary events, mandate that we consider more effective and economical strategies for the management of lipid disorders in those with CHD so that the benefits of lipid lowering can be achieved outside of clinical drug trials. The primary aims of this study are to: 1. compare the effectiveness of a nurse-managed program for lipid modification with that of usual medical care in dyslipidemic adults who have undergone CABG in achieving the goal of a LDL-cholesterol < 100 mg/dL or a > 20% reduction in LDL-cholesterol; 2. determine the physiologic, behavioral, and demographic predictors of goal attainment; 3. determine the cost effectiveness of a nurse-managed lipid-lowering program; and 4. assess the impact of lipid-lowering therapy on patients quality of life. Our goal is to optimize lifestyle modification, thereby minimizing and improving the efficacy of pharmacologic intervention. We hypothesize that a significantly higher proportion of those who participate in the nurse-managed program for lipid modification will attain the goal for lipid lowering compared to those who receive usual care from their primary providers. Additionally, we propose that the intervention is a cost-effective model of delivering lipid-lowering therapy that lends itself to widespread application.