临床指南的重要性课件.ppt

Implementing the Guidelines: Critical Pathways
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61*
18
57*
CHAMP Study: Clinical Events for the First Year After Discharge for Acute MI
CHAMP, Cardiac Hospitalization Atherosclerotic Management Program.Fonarow GC, et al. Am J Cardiol. 2001;87:819-822.
0
5
10
15
Pre-CHAMP
Post-CHAMP




*


*
Recurrent MI
Heart Failure
Hospitalization
Total Mortality
Event Rates (%)
*P<.05
Guidelines Applied in Practice (GAP)
Launched by ACC in February 2000 to
Bridge gap between ideal therapy and treatment practice
Create/implement guideline tools/processes
Initial project
Michigan hospitals
Implemented 1999 ACC/AHA AMI Guideline
Determine whether quality of care can be improved via guideline tools
Status: pilot completed, expansion now in progress
ACC, American College of Cardiology; AHA, American Heart Association; AMI, acute myocardial infarction.
GAP: Adherence Improves With Tool Use
LDL-C, low-density lipoprotein cholesterol.
Mehta RH, et al. JAMA. 287;1269-1276. (with permission)
Quality Adherence (%)
Pre-intervention
No Tool Use
Tool Use
Post-intervention
0
20
40
60
80
100
Aspirin
b-Blocker
LDL-C
Ideal Patients (n)
81
86
93
65
73
77
64
64
82
343
308
96
213
174
71
131
165
87
P =.004
P =.001
Demographics
6 clicks
Clinical/Lab
8 clicks
Discharge
meds and
interventions
7 clicks
Interactively
checks
patient’s
data with the
AHA guidelines
Importance of Data-Collection Registries
Track adherence to guidelines
Support local quality improvement programs
Compare practice patterns/outcomes with benchmarks
Comply with regulatory requirements
Provide research data
Major Data Collection Registries
NRMI
AHA Get With the Guidelines
ACC NCDR
GRACE
CRUSADE
NRMI, National Registry of Myocardial Infarction; AHA, American Heart Association; ACC NCDR, American College of Cardiology National Cardiovascular Data Reg