对心力衰竭住院患者的绩效测量和临床结果之间的关联
Gregg C Fonarow1, William T Abraham, Nancy M Albert
1University of California Los Angeles Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
JAMA
|January 4, 2007
概括
目前的心力衰竭性能测量结果与患者的结果几乎没有关联. 然而,退院时的β阻塞显著降低了心力衰竭患者的死亡风险.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 临床结果 临床结果
背景情况:
- 对心力衰竭的护理质量评估依赖于基于过程的绩效指标.
- 这些过程与改善的临床结果之间的关联在很大程度上未经测试.
研究的目的:
- 评估当前美国心脏病学会/美国心脏协会 (ACC/AHA) 对住院心力衰竭患者的绩效指标和临床结果之间的关系.
- 评估释放时β阻塞的过程-结果联系,作为潜在的绩效指标.
主要方法:
- 从美国91家医院的5791名心力衰竭患者收集前景数据 (2003年3月至2004年12月).
- 多变量和倾向调整分析,以评估ACC/AHA措施的过程结果关系.
- 评估释放时的β阻塞作为潜在的绩效指标.
主要成果:
- 在5个ACC/AHA心力衰竭性能指标中,没有一个与早期死亡率的降低有显著联系.
- 在出院时使用血管酶转化酶抑制剂或血管酶受体阻塞剂与60至90天的死亡率/再住院率降低有关.
- 出院时的β阻塞与降低死亡率和再住院风险有很强的相关性.
结论:
- 目前大多数心力衰竭性能指标对患者早期死亡率和再住院的影响最小.
- 氨转化酶抑制剂或氨受体阻断剂在排泄时的处方是例外.
- 需要额外的,经过验证的绩效测量来有效评估和改善心力衰竭护理.
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