MI-Plus: Web-Enhanced Post-MI + Cormorbidity Guidelines

描述(由申请人提供)： 背景资料。约有710万美国人是心肌梗塞(MI)的幸存者。阿拉巴马州是一个贫穷的州，非洲裔美国人的比例很高，心脏病死亡率很高，它为提高指南的遵从性提供了一个极好的实验室。到目前为止，大多数指南干预措施都集中在单个患者的病情上，但动态心肌梗死后患者往往是复杂的，有多种并存。因此，我们建议进行一项随机试验，MI-PLUS，以提高医生对复杂MI患者合并并发症指南的依从性。目标。1)从图表审查和管理数据中制定基于指南的绩效衡量标准；2)确定遵守医生指南的障碍；3)开发和实施交互式互联网干预，并定期更新；以及4)测试干预的有效性、可持续性和成本效益的假设。方法：研究方法。我们将与州医疗保险同行审查组织一起，将200名社区医生随机分配到干预或对照小组。我们为期30个月的干预是为个别医生实时定制的，包括基于案例的教育的互联网学习模块；以及通过实践概况基准的绩效反馈。我们将审查3000名联邦医疗保险患者的医疗记录和索赔数据。主要的分析是在医生层面进行的，将比较研究部门之间在指南遵从性方面的差异改善。辅助分析将检查医生特征(例如，专业)和患者特征(例如，共病、种族、性别、年龄和社会经济地位)的影响。在适当的时候，多变量技术将根据医生对患者的重复测量和分组进行调整。意义重大。该项目拥有一支经过验证的合作记录的研究团队，将产生一种基于证据和可复制的尖端干预措施，可以在“真实世界”中持续下去，很容易传播，并且很容易针对其他疾病进行修改。

DESCRIPTION (provided by the applicant): Background. Some 7.1 million Americans are Myocardial Infarction (MI) survivors. Alabama, a poor state with a high percentage of African Americans and high heart disease mortality, provides an excellent laboratory for increasing guideline adherence. To date, most guideline interventions focus on a single patient condition, but ambulatory post-MI patients are frequently complex, with multiple co-morbidities. Therefore, we propose a randomized trial, MI-plus, to increase physician adherence to guidelines for complex MI patients plus co-morbidities. Objectives. 1) Develop guideline-based performance measures from chart review and administrative data; 2) Identify barriers to physician guideline adherence; 3) Develop and implement an interactive Internet intervention, updated regularly; and 4) Test hypotheses on the intervention's effectiveness, sustainability, and cost-effectiveness. Methods. Together with the state Medicare Peer Review Organization, we will randomize 200 community-based physicians to an intervention or control arm. Our 30-month intervention, customized to the individual physician in real-time, consists of Internet learning modules with case-based education; and performance feedback with benchmarking of practice profiles. We will review medical records and claims data for 3,000 Medicare patients. The main analysis, conducted at the physician level, will compare differential improvement in guideline adherence between the study arms. Ancillary analyses will examine the effects of physician characteristics (e.g., specialty) and patient characteristics (e.g., co-morbidities, ethnicity, gender, age, and socioeconomic status). When appropriate, multivariable techniques will adjust for repeated measures and clustering of patients within physicians. Significance. With a research team that has a proven record of collaboration, this project will produce an evidence-based and replicable cutting-edge intervention that can be sustained in the "real world," readily disseminated, and easily modified for other diseases.