Quality Improvement and Outcomes for Strokes After CABG

描述(由申请人提供)：该项目将使用的技术 流行病学与质量改进对患者管理的研究 在新英格兰北部接受冠状动脉搭桥手术。这个 广泛的目标是找出降低 针对这些患者群体的不同类型的中风。具体目标是 展示改进的手术技术、对患者风险因素的认识、 护理过程的改变可能会降低不同类型的 中风。该项目的设计是基于当地旨在改善 与冠脉搭桥术相关的死亡率。该设计将利用 三管齐下。首先，新英格兰北部的心血管疾病 研究组(NNE)将使用术前临床风险预测评分 制定特定的临床干预措施，以减少这种情况的发生 手术后中风的症状。第二，来自各自的多学科团队 中心将用于制定、支持和实施这些干预措施。 最后，非国家经济实体将通过监测 中风发生率，并将这些比率与历史地区标准进行比较。这 集中实施现代持续质量管理技术 术后中风问题的改善是对 我们的工作并建立在该地区13年合作的基础上。会的 通过超越测量为心胸外科科学做出贡献 和临床护理的再工程，并且还可以提供可重现的 改善医疗和外科服务的模式。

DESCRIPTION (provided by applicant): This project will use the techniques of epidemiology and quality improvement to study the management of patients undergoing coronary artery bypass graft surgery in Northern New England. The broad objective is to identify areas of opportunity for diminishing the rate of different types of strokes for this patient population. Specific aims are to demonstrate how improved surgical technique, awareness of patient risk factors, and change in process of care may diminish the rate of different types of strokes. The project design is based on local efforts aimed at improving the mortality associated with CABG surgery. The design would utilize a three-pronged approach. First, the Northern New England Cardiovascular Disease Study Group (NNE) would utilize a preoperative clinical risk prediction score to develop specific clinical interventions aimed at diminishing the occurrence of strokes consequent to surgery. Second, multidisciplinary teams from each center would be used to develop, support and implement these interventions. Last, the NNE would assess the effect of these interventions by monitoring the rates of stroke and compare these rates to historical regional norms. This focused implementation of the techniques of modern continuous quality improvement to the problem of postoperative stroke is a logical extension of our work and builds on thirteen years of cooperation in this region. It will contribute to the science of cardiothoracic surgery by moving past measurement and toward reengineering of clinical care and may also provide a reproducible model for the improvement of medical and surgical services.