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首页> 外文学位 >Adherence to practice guidelines and heart failure patient outcomes before and after implementation of the HEARTFELT (HEART Failure Effectiveness and Leadership Team) intervention.
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Adherence to practice guidelines and heart failure patient outcomes before and after implementation of the HEARTFELT (HEART Failure Effectiveness and Leadership Team) intervention.

机译：在实施HEARTFELT（心力衰竭有效性和领导力团队）干预措施前后，都要遵守实践准则和心力衰竭患者的预后。

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摘要

HEARTFELT is a multifaceted intervention designed to improve adherence with the American College of Cardiology/American Heart Association practice guidelines for heart failure. The purpose of this research study was to assess differences in clinician outcomes (knowledge and guideline adherence) and the outcomes of elderly patients diagnosed with heart failure (length of stay and use of emergent services) before and after implementation of the HEARTFELT intervention.;A quasi-experimental, untreated control group design with separate pretest/posttest samples was employed at a community hospital in Connecticut to answer the research questions. The untreated historical control group included patients age 65 and older with the diagnosis of heart failure and a nonequivalent comparison group of patients with the diagnosis of stroke. The posttest samples included patients with the diagnosis of heart failure and stroke admitted after implementation of HEARTFELT. The HEARTFELT intervention includes the following components: an automated clinical pathway integrated with evidence-based guideline recommendations, clinician access to evidence, a heart failure patient self-management information form, discharge orders and patient self-management education form. Data were analyzed using parametric and nonparametric methods.;Findings indicate that the HEARTFELT intervention had a significant impact on some clinician outcomes, but not on patient outcomes. Significant improvement was noted in clinician adherence with addressing all self-management categories in the EMR and clinician adherence to practice guideline recommendations related to self-management education given to the patient in writing at discharge. In addition, registered nurse knowledge of guideline recommendations and physician knowledge of type three guideline recommendations improved significantly from the pretreatment to the post-treatment period.;While guideline adherence is associated with less practice variation and improved processes, methods of integration into practice in community hospital settings has been largely unexplored. The multifaceted HEARTFELT intervention shows promise towards use of informatics processes to integrate evidence at the point of care, reduce unwarranted variation in practice, improve clinician adherence with practice guidelines and ultimately improve the outcomes of individuals with heart failure.
机译：HEARTFELT是一项多方面的干预措施，旨在提高对美国心脏病学会/美国心脏协会心力衰竭实践指南的依从性。这项研究的目的是评估实施HEARTFELT干预前后的临床医生结局（知识和指南依从性）与诊断为心力衰竭的老年患者结局（住院时间和使用急诊服务）的差异。在康涅狄格州的一家社区医院采用具有单独的测试前/测试后样本的准实验，未经治疗的对照组设计来回答研究问题。未经治疗的历史对照组包括诊断为心力衰竭的65岁以上患者和诊断为中风的非对等对照组。后测样本包括实施HEARTFELT后被确诊为心力衰竭和中风的患者。 HEARTFELT干预措施包括以下组件：结合基于证据的指南建议的自动化临床途径，临床医生获取证据，心力衰竭患者自我管理信息表，出院命令和患者自我管理教育表。使用参数和非参数方法对数据进行了分析。结果表明，HEARTFELT干预对某些临床结果具有重大影响，但对患者的结果却没有影响。注意到在临床医生的依从性方面有显着改善，解决了EMR中的所有自我管理类别，并且临床医生遵循了出院时以书面形式向患者提供的与自我管理教育相关的实践准则建议。此外，从治疗前到治疗后，注册护士对指南的建议知识和对三类指南的医生知识都得到了显着改善;;虽然遵循指南与较少的实践差异和改善的流程，融入社区实践的方法相关医院设置基本上尚未开发。多方面的HEARTFELT干预措施显示出有望利用信息学过程在护理点整合证据，减少实践中不必要的变化，提高临床医生对实践指南的依从性并最终改善心力衰竭患者的预后。

著录项

  • 作者

    Dykes, Patricia C.;

  • 作者单位

    Columbia University.;

  • 授予单位 Columbia University.;
  • 学科 Health Sciences Nursing.;Health Sciences Public Health.
  • 学位 D.N.Sc.
  • 年度 2004
  • 页码 135 p.
  • 总页数 135
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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