SOFTWARE EFFECT ON PROMOTING ADHERENCE TO CHF GUIDELINES

描述（由申请人提供）：心血管疾病仍然是美国死亡率和发病率的主要原因。为了帮助医疗保健从业者将新信息整合到临床实践中，美国心脏协会、美国心脏病学会和美国心力衰竭学会等专业组织制定了临床实践指南，以促进心血管疾病管理中的循证护理标准。尽管这些指南的全面性和广泛传播，目标参数没有实现，许多患者没有得到最佳管理。次优治疗领域包括未能达到血脂和血压目标，冠状动脉疾病和房颤患者抗血小板或抗凝治疗处方不足，心肌梗死后患者β受体阻滞剂，收缩期左心室功能障碍患者β受体阻滞剂和血管紧张素转换酶抑制剂。除了未充分利用外，即使β受体阻滞剂和血管紧张素转换酶抑制剂被处方，其处方剂量也低于随机临床试验中证明其对降低发病率和死亡率具有显著作用的获益剂量。实施最佳循证指南护理的失败归因于许多原因，包括缺乏对指南的了解以及指南未能指导医疗保健提供者在个体患者中实施指南的策略。为了便于将这些治疗指南纳入日常医疗实践，开发了心脏目标计划软件，以根据使用既定指南的I类或A级建议，将心血管疾病管理所必需的数据迅速输入标准化的计算机化表格（带有提醒系统）。本提案的主要目的是：1）将β受体阻滞剂和血管紧张素转换酶抑制剂治疗算法纳入我们现有的心脏目标计划; 2）采用可用性方法，包括与医生、护士和医生助理进行深入访谈和焦点小组，以根据获得的反馈进一步完善软件。如果这个决策支持系统是成功的，并广泛实施，从照顾慢性心力衰竭的最佳结果可能会实现。

DESCRIPTION (provided by applicant): Cardiovascular disease continues to be the leading cause of mortality and morbidity in the United States. To assist health care practitioners in their integration of new information into clinical practice, professional organizations such as the American Heart Association, American College of Cardiology, and Heart Failure Society of America have developed clinical practice guidelines to promote evidence-based standards of care in the management of cardiovascular disease. Despite the comprehensive nature and widespread dissemination of these guidelines, target parameters are not being achieved, and many patients are not managed optimally. Areas of suboptimal care include failure to achieve lipid and blood pressure goals, underprescribing of antiplatelet or anticoagulant therapy in patients with coronary artery disease and atrial fibrillation, beta-blockers in patients post myocardial infarction, and beta-blockers and angiotensin converting enzyme inhibitors in patients with systolic left ventricular dysfunction. In addition to being underutilized, even when beta-blockers and angiotensin converting enzyme inhibitors are prescribed they are prescribed at doses below those proven to be of benefit in the randomized clinical trials that demonstrated their significant effect on reducing morbidity and mortality. The failure of implementation of optimal evidence-based guideline care has been attributed to a number of reasons including lack of knowledge of the guidelines and the failure of the guidelines to instruct the health care provider on strategies to implement the guidelines in individual patients. To facilitate the incorporation of these treatment guidelines into everyday medical practice, the Cardiac Goal Program software was developed to prompt entry of data essential to the management of cardiovascular disease, based on Class I or Grade A recommendations using established guidelines, into standardized, computerized forms with a reminder system. The primary aims of this proposal are 1) to incorporate beta-blocker and angiotensin converting enzyme inhibitor treatment algorithms into our existing Cardiac Goal Program and 2) employ usability methodologies, including in-depth interviews and focus groups with physicians, nurses, and physician assistants, to further refine the software based on the feedback obtained. If this decision support system is successful and widely implemented, the best outcomes from care for chronic heart failure may be achieved.