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首页> 外文期刊>International Journal for Quality in Health Care >Is quality improvement sustainable? Findings of the American college of cardiology's guidelines applied in practice
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Is quality improvement sustainable? Findings of the American college of cardiology's guidelines applied in practice

机译：质量改进是否可持续？在实践中应用美国心脏病学会指南的发现

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Objective, (i) To examine the sustainability of an in-hospital quality improvement (QI) intervention, the American College of Cardiology's Guideline Applied to Practice (GAP) in acute myocardial infarction (AMI), (ii) To determine the predictors of physician adherence to AMI guidelines-recommended medication prescribing. Design. Prospective observational study. Setting. Five mid-Michigan community hospitals. Participants. 516 AMI patients admitted consecutively I year after the GAP intervention. These patients were compared with 499 post-GAP patients. Main Outcome Measures. The main outcome was adherence to medication use guidelines. Predictors of medication use were determined using multivariable logistic regression analysis. Results. I year after GAP implementation, adherence to most medications remained high. We found a significant increase in beta-blocker (BB) use in-hospital (87.9 vs. 72.1%, P <0.001) whereas cholesterol assessment within 24 h (79.5 vs. 83.6%, P> 0.225) did not change significantly. However, discharge aspirin (83 vs. 90%, P< 0.018) and BB prescriptions (84 vs. 92%, P< 0.016) dropped to preintervention rates. Discharge angiotensin-converting enzyme inhibitor and treatment of patients with low-density lipoprotein of >100 were unchanged. Predictors of receiving appropriate medications were male gender (for aspirin and BBs) and treatment with percutaneous coronary intervention compared with coronary artery bypass graft. Notably, prescription rates for discharge medications differed significantly by hospital. Conclusions. Early benefits of the Mid-Michigan GAP intervention on guideline use were only partially sustained at I year. Differences in guideline adherence by treatment modality and hospital demonstrate challenges for follow-up phases of GAP Additional strategies to improve sustainability of QI efforts are urgently needed.
机译：目的：（i）为检查院内质量改善（QI）干预措施的可持续性，美国心脏病学会在急性心肌梗死（AMI）中应用实践指南（GAP），（ii）确定医师的预测指标遵守AMI指南的推荐用药处方。设计。前瞻性观察研究。设置。密歇根州中部的五家社区医院。参加者GAP干预一年后，连续516例AMI患者入院。将这些患者与499名GAP后患者进行了比较。主要观察指标。主要结果是遵守药物使用指南。使用多变量逻辑回归分析确定药物使用的预测因素。结果。在实施GAP的第一年，对大多数药物的依从性仍然很高。我们发现院内使用β受体阻滞剂（BB）的比例显着增加（87.9比72.1％，P <0.001），而24小时内的胆固醇评估（79.5比83.6％，P> 0.225）没有显着变化。但是，出院阿司匹林（83比90％，P <0.018）和BB处方（84比92％，P <0.016）降至干预前的比率。排出血管紧张素转换酶抑制剂和低密度脂蛋白> 100的患者的治疗均未改变。接受适当药物治疗的预测指标是男性（阿司匹林和BBs），并且与冠状动脉搭桥术相比，经皮冠状动脉介入治疗是有效的。值得注意的是，出院用药的处方率差异很大。结论密歇根州中部GAP干预措施对指南使用的早期收益在I年仅得到部分维持。治疗方式和医院对指南依从性的差异表明，GAP后续阶段面临挑战，迫切需要其他策略来提高QI的可持续性。

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