冠状动脉旁路移植手术后的动脉样硬化二次预防绩效测量与Get With the Guidelines数据库中的皮肤通道导管干预和非干预患者相比
Loren F Hiratzka1, Kim A Eagle, Li Liang
1Cardiac Vascular and Thoracic Surgeons, Inc., Cincinnati, Ohio, USA. loren_hiratzka@trihealth.com
Circulation
|September 14, 2007
概括
与非手术患者相比,冠状动脉旁路移植 (CABG) 患者对二次预防措施的遵守程度不同. 需要改进过程,以提高接受指导方针导向医疗治疗的CABG患者的护理.
科学领域:
- 心脏病学 心脏病学
- 改善医疗保健质量 改善医疗保健质量
- 公共卫生 公共卫生
背景情况:
- 美国心脏协会 Get With the Guidelines-冠状动脉疾病计划旨在改善动脉样硬化风险降低策略.
- 冠状动脉旁路移植 (CABG) 手术患者可能会经历不同的护理途径,影响他们遵守二次预防措施.
研究的目的:
- 为了在Get With the Guidelines-冠状动脉疾病计划中,在CABG患者和非手术患者之间比较遵守二次预防绩效指标.
主要方法:
- 总共有119,106名患者被分析:有14,118名患者接受了CABG,有58,702名患者接受了皮肤通道干预,46,286名患者没有接受任何干预.
- 评估了对药物的遵守 (阿司匹林,β抑制剂,ACE抑制剂,降脂药物) 和戒烟咨询.
- 对14个临床变量进行了统计调整,以比较结果.
主要成果:
- 与皮肤导管干预患者相比,CABG患者接受大多数二次预防措施的可能性较低.
- 然而,CABG患者更有可能接受阿司匹林,β抑制剂和戒烟咨询,而不是接受任何干预的患者.
- 复合粘附率和无缺陷率在皮肤导管干预患者中最高,在调整后未接受任何干预的患者中最低.
结论:
- 对于CABG与非手术患者的医院出院遵守二次预防措施存在显著差异.
- 护理流程的差异可能导致这些合规差异,需要进一步调查.
- 针对CABG患者的定向质量改善干预措施至关重要,因为二次预防在这个人群中已被证明有好处.
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