ASSESSING AND IMPROVING CARDIOVASCULAR DISEASE PRACTICES

描述 （摘自申请人摘要）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。 尽管它们会造成破坏，但这些力量可能会促进 一种将预防放在核心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 不可避免的 目前的机制，重新设计护理，以满足这些 挑战不足。 这项建议旨在培养一名年轻的医生 变革管理的新科学。 通过这个奖项，兰德尔S。 斯塔福德，医学博士，博士将建立在他的经验，内科， 流行病学和卫生保健管理，以发展研究事业 致力于提高医疗质量。 拟议研究的目的是使用数据驱动的定量 设计、实施和评估质量改进工作的方法。 它 国家数据分析与当地临床改善的独特配对 举措 1973- 1995年全国门诊医疗调查数据 1991- 1994年医疗保险现行受益人调查将被分析。 这 调查将集中在心血管疾病预防和治疗方面。 多变量统计分析将测试研究假设，解决： 1)目前做法的适当性，2）种族、性别、健康 保险和医师专业的实践模式，和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 举措 地方项目将能够更好地确定问题的优先次序， 面对质量实践的障碍，并确定影响的方法 医生 本提案的研究环境将包括 合作伙伴医疗保健系统（马萨诸塞州总医院[MGH]和 布里格姆妇女医院（Brigham and Women's Hospital） 研究分析将在 麻省总医院普通内科 临床改善项目将 包括：1）增加心房肌抗凝治疗的倡议 纤颤，2）加强医院关键路径，强调 预防，3）门诊质量指标的制定和使用 心血管疾病的做法，和4）社区为导向的评价 在马萨诸塞州查尔斯敦，采取措施降低缺血性心脏病的风险。 这些 自然实验将允许严格检验 质量改进的努力。 最有希望的举措将形成 可以传播到其他卫生保健机构的模型系统， 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.