Get With the Guidelines-Strokeは,急性脳卒中または一時的な不血症発作で入院した患者の治療の持続的な改善と関連しています
Lee H Schwamm1, Gregg C Fonarow, Mathew J Reeves
1Massachusetts General Hospital, Boston, MA 02114, USA. lschwamm@partners.org
Circulation
|December 17, 2008
まとめ
Get With the Guidelines-Strokeプログラムへの参加は,脳卒中ケアガイドラインの遵守を大幅に改善しました. この品質改善イニシアチブは,参加したすべての病院でよりよい脳卒中治療につながりました.
科学分野:
- 神経学 神経学とは
- 公衆衛生は公衆衛生である.
- 医療の質の向上 医療の質の向上
背景:
- 脳卒中および一時性性イシュケミア発作 (TIA) 治療に関する根拠に基づいたガイドラインの遵守は,依然として最適ではない.
- 脳卒中のケアにおけるガイドラインの遵守を改善することを目的とした介入の評価が必要である.
研究 の 目的:
- Get With the Guidelines-Strokeプログラムへの参加が,脳卒中ケアガイドラインの遵守の向上と関連しているかどうかを判断する.
主な方法:
- 2003年から2007年にかけて,米国の790の病院を対象とした前向きな,ランダム化されていない,全国的な品質改善プログラムです.
- 7つのパフォーマンス測定値と複合測定値の遵守度合いを測定し,イシュケミア性脳卒中またはTIAを患った322,847人の患者を対象とした.
- 時間の経過とともにアデランスの改善に関連する要因を分析するために,一般的な推定方程式を使用しました.
主要な成果:
- Get With the Guidelines-Strokeへの参加は,ベースラインから5年までの7つの個々のおよび複合的な遵守測定値のすべてにおいて有意な改善と関連していました.
- 特定の改善には,静脈内血栓抑制薬,早期および出院時の抗血栓薬,DVT予防,心房動抗凝固薬,脂質治療,禁煙の増加が含まれています.
- 多変量分析は,世俗的な傾向とは無関係に,介護の機会を満たす確率は年1.18倍増加することを示しました.
結論:
- Get With the Guidelines-Strokeプログラムへの参加は,すべての脳卒中パフォーマンス測定値への遵守の増加につながりました.
- 脳卒中治療の顕著な改善は,病院の規模,地理的位置,または教員の地位に関係なく,すべての病院で観察されました.
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