慢性脏疾病住院率的实用试验
Miguel A Vazquez1, George Oliver1, Ruben Amarasingham1
1From the Department of Internal Medicine (M.A.V., P.B., S.M.P., R.T.M., S.H., B.B., R.D.T.) and the Peter O'Donnell Jr. School of Public Health (C.A., S.Z.), University of Texas Southwestern Medical Center, the Parkland Center for Clinical Innovation (G.O., V.S., A.J., T.-M.N.), Pieces Technologies (R.A.), Veterans Affairs of North Texas Health Care System (R.T.M., S.H., J.H.), Parkland Health (B.M., N.S.), and Texas Health Resources (F.V., L.M.) - all in Dallas; the National Institute of Diabetes and Digestive and Kidney Diseases (K.C.) and the National Heart, Lung, and Blood Institute (B.W.) - both in Bethesda, MD; ProHealth Physicians, Farmington, CT (T.P.M.); and the State University of New York, Buffalo (C.F.).
基于EHR的算法和辅助器并没有减少慢性病,糖尿病和高血压患者的住院治疗. 这种干预措施并没有改善初级保健机构的结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 内分泌学 在内分泌学.
- 心脏病学 心脏病学
- 主要护理医学 医疗保健
背景情况:
- 对于慢性病,2型糖尿病和高血压 (功能障碍三位一体) 存在有效的治疗方法.
- 缺乏大规模试验来评估指导方针导向治疗的实施,以减少这一群体的死亡率和并发症.
研究的目的:
- 评估基于电子健康记录 (EHR) 的算法和实践促进者的有效性,以改善指导方针导向治疗的交付.
- 确定这种干预措施对患有功能障碍三元组的患者住院率和其他不良结果的影响.
主要方法:
- 一个开放标签,集群随机试验,涉及11,182名患者在141个初级保健诊所.
- 干预组接受了基于电子健康记录的算法和实践辅导员;对照组接受了通常的护理.
- 主要结局是1年内因任何原因住院;次要结局包括心血管事件,透析和死亡.
主要成果:
- 在干预 (20.7%) 和常规护理 (21.1%) 组之间,1年后住院率没有显著差异 (P=0.58).
- 在两组中,急诊室访问,再入院,心血管事件,透析和死亡都有类似的风险.
- 在干预组观察到急性损伤的风险增加 (12.7%对11.3%).
结论:
- 基于EHR的算法与实践辅导员相结合并没有降低慢性病,2型糖尿病和高血压患者的1年住院率.
- 干预没有证明对其他关键次要结果有显著的好处.
- 研究结果表明,这种实施策略可能无法有效地改善初级保健机构中高风险人群的临床结果.
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