临床指南的重要性.ppt

Implementing the Guidelines: Critical Pathways
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Awareness Is Not Enough!
NCEP, National Cholesterol Education Program
Pearson TA, et al Arch Intern Med 2000;160:459-467
95%
38%
0
20
40
60
80
100
Physician Awareness of
NCEP Guideline
Patient Treated to Goal
Sample (%)
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GUIDELINES
Cardiology
Acute Care
Primary Care
Secondary Prevention
Smooth Transition From Acute to Long-term Management
特掣焦肠辙依铭氨雏屿桓悼阵洛碘湾耻及煮映帕静安嗡毖虐敦绿凌妓厦愿临床指南的重要性临床指南的重要性
Why Develop Critical Pathways?
“A treatment gap between therapy that is dictated by evidence-based medicine and therapy that occurs in practice is not a deficit of knowledge; rather, it is a deficit of implementation”
Sidney Smith, MD
Chief Scientific Officer,  American Heart Association
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Standardized protocols
Goal: optimize care
Emerging Evidence— Pathways work:
CHAMP
Guidelines Applied in Practice (GAP)
AHA Get with the Guidelines program
wwwcritpathcardiocom
CHAMP, Cardiac Hospitalization Atherosclerotic Management Program
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UCLA: CHAMP Study
Designed to determine whether physician/patient compliance with preventive therapies can be improved through a hospital-initiated program
Tracked initiation of ASA, -blocker, ACE inhibitor, and statins
Used preprinted orders, guidelines, lectures, discharge forms
Population: Patients with symptomatic atherosclerosis treated at university-associated teaching hospital
ASA, acetylsalicyclic acid; ACE, angiotensin-converting enzyme
Fonarow GC, et al Am J Cardiol 2000;85;10A-17A
Cardiac Hospitalization Atherosclerosis Management Program
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CHAMP Study: Treatment Rates at Discharge and 1-Year Follow-up
CHAMP, Cardiac Hospitalization Atherosclerotic Management Program
* P<01 pre- vs post-CHAMP at discha