临床指南的重要性课件.ppt

临床指南的重要性课件.pptImplementing the Guidelines: Critical Pathways
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 (%)
GUIDELINES
Cardiology
Acute Care
Primary Care
Secondary Prevention
Smooth Transition From Acute to Long-term Management
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
Standardized protocols
Goal: optimize care
Emerging Evidence— Pathways work:
CHAMP
Guidelines Applied in Practice (GAP)
AHA Get with the Guidelines program

CHAMP, Cardiac Hospitalization Atherosclerotic Management Program.
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
CHAMP Study: Treatment Rates at Discharge and 1-Year Follow-up
CHAMP, Cardiac Hospitalization Atherosclerotic Management Program.
* P<.01 pre- vs post-CHAMP at discharge and at 1 year.  Fonarow GC, et al. Am J Cardiol. 2001;87:819-822.
0
50
100
Pre-CHAMP Discharge
Post-CHAMP Discharge
Pre-CHAMP Follow-up
Post-CHAMP Follow-up
Aspirin
-Blocker
Treatment Rates (%)
78
92*
68
94*
12
61*
18
57*
CHAMP Study: Clinical Events for the