Improving Quality of Care for Acute Myocardial InfarctionThe Guidelines Applied in Practice (GAP) Initiative
| Autor: | Rajendra H. Mehta, Angela Blount, Michele J. Orza, Robert Parrish, Arthur Riba, Mary Jo Smith, Steven Borzak, Cecelia K. Montoye, Mary Franklin, Thomas LaLonde, Paul A. Sobotka, Patricia L. Baker, Meg Gallogly, Martha Satwicz, Jessica D. Faul, Canopy Roychoudhury, Stuart R. Winston, Marge Freundl, Susan Fox, Kim A. Eagle, Eva Kline-Rogers |
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| Rok vydání: | 2002 |
| Předmět: |
medicine.medical_specialty
Aspirin Quality management Evidence-based practice business.industry medicine.medical_treatment General Medicine Guideline medicine.disease Acute care Emergency medicine medicine Physical therapy Smoking cessation Myocardial infarction business Quality assurance medicine.drug |
| Zdroj: | JAMA. 287:1269 |
| ISSN: | 0098-7484 |
| Popis: | ContextQuality of care of patients with acute myocardial infarction (AMI) has received intense attention. However, it is unknown if a structured initiative for improving care of patients with AMI can be effectively implemented at a wide variety of hospitals.ObjectiveTo measure the effects of a quality improvement project on adherence to evidence-based therapies for patients with AMI.Design and SettingThe Guidelines Applied in Practice (GAP) quality improvement project, which consisted of baseline measurement, implementation of improvement strategies, and remeasurement, in 10 acute-care hospitals in southeast Michigan.PatientsA random sample of Medicare and non-Medicare patients at baseline (July 1998–June 1999; n = 735) and following intervention (September 1–December 15, 2000; n = 914) admitted at the 10 study centers for treatment of confirmed AMI. A random sample of Medicare patients at baseline (January–December 1998; n = 513) and at remeasurement (March–August 2001; n = 388) admitted to 11 hospitals that volunteered, but were not selected, served as a control group.InterventionThe GAP project consisted of a kickoff presentation; creation of customized, guideline-oriented tools designed to facilitate adherence to key quality indicators; identification and assignment of local physician and nurse opinion leaders; grand rounds site visits; and premeasurement and postmeasurement of quality indicators.Main Outcome MeasuresDifferences in adherence to quality indicators (use of aspirin, β-blockers, and angiotensin-converting enzyme [ACE] inhibitors at discharge; time to reperfusion; smoking cessation and diet counseling; and cholesterol assessment and treatment) in ideal patients, compared between baseline and postintervention samples and among Medicare patients in GAP hospitals and the control group.ResultsIncreases in adherence to key treatments were seen in the administration of aspirin (81% vs 87%; P = .02) and β-blockers (65% vs 74%; P = .04) on admission and use of aspirin (84% vs 92%; P = .002) and smoking cessation counseling (53% vs 65%; P = .02) at discharge. For most of the other indicators, nonsignificant but favorable trends toward improvement in adherence to treatment goals were observed. Compared with the control group, Medicare patients in GAP hospitals showed a significant increase in the use of aspirin at discharge (5% vs 10%; P |
| Databáze: | OpenAIRE |
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