临床指南的重要性课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Implementing the Guidelines:Critical Pathways,Implementing the Guidelines:,Awareness Is Not Enough!,NCEP,National Cholesterol Education Program.,Pearson TA,et al.,Arch Intern Med.,2000;160:459-467.,95%,38%,0,20,40,60,80,100,Physician Awareness of,NCEP Guideline,Patient Treated to Goal,Sample(%),Awareness Is Not Enough!NCEP,GUIDELINES,Cardiology,Acute Care,Primary Care,Secondary Prevention,Smooth Transition From Acute to Long-term Management,GUIDELINESCardiologyPrimary Ca,Why Develop Critical Pathways?,“A treatment gap between therapy that is dictated by evidence-based medicine and therapy that occurs in practice is not a deficit of knowledge;rather,it is a deficit of implementation.”,Sidney Smith,MD,Chief Scientific Officer,American Heart Association,Why Develop Critical Pathways?,Standardized protocols,Goal:optimize care,Emerging Evidence,Pathways work:,CHAMP,Guidelines Applied in Practice(GAP),AHA,Get with the Guidelines,program,CHAMP,Cardiac Hospitalization Atherosclerotic Management Program.,Standardized protocols www.cri,UCLA:CHAMP Study,Designed to determine whether physician/patient compliance with preventive therapies can be improved through a hospital-initiated program,Tracked initiation of ASA,-blocker,ACE inhibitor,and statins,Used preprinted orders,guidelines,lectures,discharge forms,Population:Patients with symptomatic atherosclerosis treated at university-associated teaching hospital,ASA,acetylsalicyclic acid;ACE,angiotensin-converting enzyme.,Fonarow GC,et al.,Am J Cardiol.,2000;85;10A-17A.,Cardiac Hospitalization Atherosclerosis Management Program,UCLA:CHAMP StudyDesigned to d,CHAMP Study:Treatment Rates at Discharge and 1-Year Follow-up,CHAMP,Cardiac Hospitalization Atherosclerotic Management Program.,*,P,.01 pre-vs post-CHAMP at discharge and at 1 year.Fonarow GC,et al.,Am J Cardiol.,2001;87:819-822.,0,50,100,Pre-CHAMP Discharge,Post-CHAMP Discharge,Pre-CHAMP Follow-up,Post-CHAMP Follow-up,Aspirin,-Blocker,Treatment Rates(%),78,92*,68,94*,12,61*,18,57*,CHAMP Study:Treatment Rates a,CHAMP Study:Clinical Events for the First Year After Discharge for Acute MI,CHAMP,Cardiac Hospitalization Atherosclerotic Management Program.Fonarow GC,et al.,Am J Cardiol.,2001;87:819-822.,0,5,10,15,Pre-CHAMP,Post-CHAMP,7.8,4.7,14.8,7.0,3.1*,2.6,7.6,3.3*,Recurrent MI,Heart Failure,Hospitalization,Total Mortality,Event Rates(%),*P,.05,CHAMP Study:Clinical Events f,Guidelines Applied in Practice(GAP),Launched by ACC in February 2000 to,Bridge gap between ideal therapy and treatment practice,Create/implement guideline tools/processes,Initial project,Michigan hospitals,Implemented 1999 ACC/AHA AMI Guideline,Determine whether quality of care can be improved via guideline tools,Status:pilot completed,expansion now in progress,ACC,American College of Cardiology;AHA,American Heart Association;AMI,acute myocardial infarction.,Guidelines Applied in Practice,GAP:Adherence Improves With Tool Use,LDL-C,low-density lipoprotein cholesterol.,Mehta RH,et al.,JAMA,.287;1269-1276.(with permission),Quality Adherence(%),Pre-intervention,No Tool Use,Tool Use,Post-intervention,0,20,40,60,80,100,Aspirin,b,-Blocker,LDL-C,Ideal Patients(n),81,86,93,65,73,77,64,64,82,343,308,96,213,174,71,131,165,87,P,=.004,P,=.001,GAP:Adherence Improves With T,Demographics,6 clicks,Clinical/Lab,8 clicks,Discharge,meds and,interventions,7 clicks,Interactively,checks,patients,data with the,AHA guidelines,DemographicsClinical/LabDischa,Importance of Data-Collection Registries,Track adherence to guidelines,Support local quality improvement programs,Compare practice patterns/outcomes with benchmarks,Comply with regulatory requirements,Provide research data,Major Data Collection Registries,NRMI,AHA,Get With the Guidelines,ACC NCDR,GRACE,CRUSADE,NRMI,National Registry of Myocardial Infarction;AHA,American Heart Association;ACC NCDR,American College of Cardiology National Cardiovascular Data Registry;GRACE,Global Registry of Acute Coronary Events;CRUSADE,Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines.,Importance of Data-Collection,Current Use of ACS Rx in US(Jan-July 2002),C,an,R,apid Risk Stratification of,U,nstable Angina Patients,S,uppress,AD,verse Outcomes with,E,arly Implementation,of the ACC/AHA Guidelines,300 Hospitals,19,000 Patients,ACS,acute coronary syndrome;ACC,American College of Cardiology;AHA,American Heart Association.,Roe,et al.ESC 2002.,Current Use of ACS Rx in US(J,Discharge Medication Use,PCI,percutaneous coronary intervention;ASA,acetylsalicylic acid;ACE,angiotensin-converting enzyme;LVEF,left ventricular ejection fraction;CHF,coronary heart disease;DM,diabetes mellitus;HTN,hypertension;TC,total cholesterol;LDL,low-density lipoprotein.,*LVEF 40%,CHF,DM,HTN,Known hyperlipidemia,TC,LDL,Roe,et al.ESC.2002.,88,80,59,77,49,0,20,40,60,80,100,ASA,-Blockers,ACEInhibitors