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Should this study change my practice?

ACADEMIC EMERGENCY MEDICINE 2003年第5期10卷 417-422页

作者： Cone, DC Lewis, RJ Yale Univ Sch Med Sect Emergency Med New Haven CT 06510 USA Harbor UCLA Med Ctr Dept Emergency Med Torrance CA 90509 USA

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Specialty care for heart failure: Does it improve outcomes?

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AMERICAN HEART JOURNAL 2003年第2期145卷 209-213页

作者： Massie, BM Ansari, MN San Francisco VA Med Ctr Div Cardiol San Francisco CA USA Univ Calif San Francisco Dept Med San Francisco CA 94143 USA Univ Calif San Francisco Cardiovasc Res Inst San Francisco CA 94143 USA

Am Heart J 2003;145:209-13.

关键词：心脏病学/标准疾病管理坚持准则心肌梗死/死亡率心肌梗死/治疗医师诊疗模式/标准初级卫生保健/标准治疗结果人类

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Care and outcomes of elderly patients with acute myocardial infarction by physician specialty: The effects of comorbidity and functional limitations

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AMERICAN JOURNAL OF MEDICINE 2000年第6期108卷 460-469页

作者： Chen, J Radford, MJ Wang, Y Krumholz, HM Yale Univ Sch Med Dept Med Cardiovasc Surg Sect New Haven CT 06520 USA Yale Univ Sch Med Dept Epidemiol & Publ Hlth Sect Chron Dis Epidemiol New Haven CT 06520 USA Yale New Haven Hosp Ctr Outcomes Res & Evaluat New Haven CT 06504 USA Qualidigm Middletown CT USA

PURPOSE: Whether patients with acute myocardial infarction who are treated by cardiologists have better outcomes than patients treated by generalist physicians is controversial. Because some of the survival benefit associated with cardiology care may be due to baseline differences in patient characteristics, we evaluated how differences in case-mix of comorbid illness and functional limitations may explain the association between specialty care and survival. MATERIALS AND METHODS: We examined the records of 109,243 Medicare beneficiaries hospitalized for myocardial infarction from 1994 to 1995 from the national Cooperative Cardiovascular Project to evaluate the association of physician specialty with 30-day and I-year mortality. We assessed the extent to which this relation was mediated by differences in the use of guideline-supported therapies (aspirin, beta-blockers, reperfusion. angiotensin-converting enzyme inhibitors) or differences in the clinical characteristics of the patients. RESULTS: Patients who had board-certified cardiologists as attending physicians had the least number of comorbid conditions, whereas patients who had general practitioners or internal medicine subspecialists as attending physicians usually had the most comorbidities. Cardiologists had the greatest use of most guideline-supported therapies, and general practitioners had the lowest use. After adjustment for severity of myocardial infarction, clinical presentation, and hospital characteristics, patients treated by cardiologists were less likely to die within 1 year (relative risk [RR] = 0.92, 95%, confidence interval [CI]: 0.89 to 0.95), and patients cared for by other general practitioners were more likely to die within 1 year (RR = 1.09, 95% CI: 1.03 to 1.14), than patients cared for by general internists. After adjusting for additional measures of comorbid illness and functional limitations, the 1-year survival benefit associated with cardiology care was attenuated relative to interni

关键词：日常生活活动心脏病学/标准共病现象家庭医学/标准老年人身心健康评价医院死亡率住院内科学/标准 Medicare 心肌梗死/并发症心肌梗死/死亡率心肌梗死/治疗医师诊疗模式/标准诊疗准则(主题) 质量指标卫生保健回顾性研究疾病严重程度指数存活率分析治疗结果美国/流行病学老年人女(雌)性人类男(雄)性

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Variations in psychiatric practice - Neither unacceptable nor unavoidable, only under-researched

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BRITISH JOURNAL OF PSYCHIATRY 1999年第4期175卷 303-305页

作者： Gilbody, S House, A Univ York NHS Ctr Reviews & Disseminat York YO10 5DD N Yorkshire England Univ Leeds Div Psychiat & Behav Sci Leeds LS2 9JT W Yorkshire England

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Defining the utility of clinically acceptable variations in evidence-based practice guidelines for evaluation of quality improvement activities

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EVALUATION & THE HEALTH PROFESSIONS 1999年第3期22卷 298-324页

作者： Lescoe-Long, M Long, MJ Wichita State Univ Dept Publ Hlth Sci Wichita KS 67260 USA

This study examines the utility of systematically accounting for acceptable physician variations in guideline application. The results argue against assuming that even seemingly noncontentious guideline protocol offer a threshold of variation similar to con ventional Continuous Quality Improvement (CQI) assessment standards. Findings also suggest that health service organizations can derive greater benefits from expending the resources necessary to standardize guidelines if compliance with both the medical review criteria, and the guidelines as originally cart structed, is monitored as part of the evaluation activity. (C) 1999 Sage Publications, Inc.

关键词：急性病医务工作者的态度加拿大临床医学/方法评价研究循证医学卫生服务研究医学审核心肌梗死/药物疗法医师诊疗模式/标准全面质量管理/标准人类

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An intensive communication intervention for the critically ill

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AMERICAN JOURNAL OF MEDICINE 2000年第6期109卷 469-475页

作者： Lilly, CM De Meo, DL Sonna, LA Haley, KJ Massaro, AF Wallace, RF Cody, S Brigham & Womens Hosp Div Resp Dept Med Combined Program Pulm & Crit Care Med Boston MA 02115 USA Harvard Univ Sch Med Boston MA USA USA Environm Med Res Inst Natick MA 01760 USA

PURPOSE: We sought to determine the effects of a communication process that was designed to encourage the use of advanced supportive technology when it is of benefit, but to limit its burdens when it is ineffective. We compared usual care with a proactive, multidisciplinary method of communicating that prospectively identified for patients and families the criteria that would determine whether a care plan was effective at meeting the goals of the patient. This process allowed caregivers to be informed of patient preferences about continued advanced supportive technology when its continuation would result in a compromised functional outcome or death. MATERIALS AND METHODS: We performed a before-and-after study in 530 adult medical patients who were consecutively admitted to a university tertiary care hospital for intensive care. Multidisciplinary meetings were held within 72 hours of critical care admission. Patients, families, and the critical care team discussed the care plan and the patients' goals and expectations for the outcome of critical care. Clinical "milestones" indicative of recovery were identified with time frames for their occurrence. Follow-up meetings were held to discuss palliative care options when continued advanced supportive technology was not achieving the patient's goals. We measured length of stay, mortality, and provider team and family consensus in 134 patients before the intensive communication intervention and in 396 patients after the intervention. RESULTS: Intensive communication significantly reduced the median length of stay from 4 days (interquartile range, 2 to 11 days) to 3 days (2 to 6 days, P = 0.01 by survival analysis). This reduction remained significant after adjustment for acute physiology and chronic health evaluation (APACHE) 3 score [risk ratio (RR) = 0.81;95% confidence interval (CI), 0.66 to 0.99;P = 0.04). Subgroup analysis revealed that this reduction occurred in our target group, patients with acuity scores in the hi

关键词：急性病生理学和长期健康评价波士顿/流行病学病例管理信息交流卫生服务研究医院死亡率重症监护/方法重症监护/标准重症监护病房/统计学和数值数据住院时间 Logistic模型马萨诸塞/流行病学比值比姑息疗法病人医疗护理计划病人医疗小组医师诊疗模式/标准医师诊疗模式/统计学和数值数据比例危险度模型前瞻性研究疾病严重程度指数存活率分析工艺学医学老年人女(雌)性人类男(雄)性中年人

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A GRiPPing yarn--getting research into practice: a case study.

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Health libraries review 1994年第4期11卷 269-277页

作者： Needham, G. Buckinghamshire Health Authority Aylesbury United Kingdom

This article describes the GRiPP initiative in the (old) Oxford Region which set out to explore the potential role of purchasers or commissioners of health care in putting the findings of research into the practice of healthcare. A short account of the background to GRiPP is followed by a more detailed description of the GRiPP project carried out in Buckinghamshire and some of the lessons which may be useful to other health authorities. The final section of the article considers the role of the healthcare librarian in the context of 'Getting Research into Practice and Purchasing'.

关键词：刮宫术/标准刮宫术/利用大不列颠月经过多/治疗医师诊疗模式/标准医师家庭卫生保健质量公费医疗/标准成年人女(雌)性人类

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Missed immunization opportunities: a comparison of nurse practitioners and physicians.

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Journal of the American Academy of Nurse Practitioners 1999年第10期11.0卷 423-429页

作者： Clayton, M.F. Boegel, E. Physicians Goldsboro NC United States

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MEDICAL-TREATMENT EFFECTIVENESS RESEARCH - A VIEW FROM INSIDE THE AGENCY FOR HEALTH-CARE POLICY AND RESEARCH

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EVALUATION & THE HEALTH PROFESSIONS 1991年第2期14卷 161-186页

作者： RASKIN, IE MAKLAN, CW [o_1]Agency for Health Care Policy and Research

The Medical Treatment Effectiveness Program (MEDTEP) is an intradepartmental federal program of the Department of Health and Human Services, for which the Agency for Health Care Policy and Research (AHCPR) has lead responsibility. This article presents a staff perspective on the conceptual framework for the MEDTEP research agenda and on the opportunity to address empirically the relationships between particular health care services and patient outcomes. It reviews programmatic priorities and identifies active MEDTEP research projects, with descriptions of 11 patient outcomes research team projects. Finally, it addresses the need to produce useful research findings in the short term and the implications of a dual concern for the quality and cost of health care.

关键词：数据库事实型革新推广卫生工作重点卫生服务研究/标准组织目标结果与过程评价(卫生保健)/方法医师诊疗模式/标准质量保证卫生保健/组织和管理美国人类

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The hour of birth: comparisons of circadian pattern between women cared for by midwives and obstetricians

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MIDWIFERY 2000年第3期16卷 173-176页

作者： Heres, MHG Pel, M Borkent-Polet, M Treffers, PE Mirmiran, M Univ Amsterdam Acad Med Ctr Dept Obstet & Gynaecol NL-1105 AZ Amsterdam Netherlands Univ Amsterdam Netherlands Inst Brain Res Amsterdam Netherlands

Objective: to examine the difference, if any, between midwives' care and obstetricians' care in the circadian pattern of the hour of birth in spontaneous labour and delivery. Design: a descriptive study comparing the circadian pattern of the hour of birth between women caved for by a midwife or an obstetrician. Setting: data were derived from the Perinatal Database of the Netherlands (LVR), comprising 83% of all births under midwives' care and 75% of all births under obstetricians' care. Subjects: 57 871 women receiving midwives' care and 31 999 women receiving obstetricians' care with spontaneous labour and spontaneous delivery. Main outcome measures: differences in the circadian rhythms beween women receiving midwives' care and obstetricians' care, Findings: there was a difference in the circadian pattern of the hour of birth between midwives' and obstetricians' care. Beak times differed 5.43 hours (CI 4.23-7.03) for primiparous and 3.34 hours (CI 3.00-4.08) for multiparous women between the midwives' group and the obstetricians' group. Conclusion: this study demonstrates a remarkable difference in circadian pattern of the hour of birth between midwives' care and obstetricians' care. In obstetricians' care the duration of normal labour appears to be prolonged, presumably by an increased level of stress. In normal birth the care of midwives is preferable. (C) 2000 Harcourt Publishers Ltd.

关键词：昼夜节律接生产科引产分娩过程/心理学助产学/标准自然分娩/方法自然分娩/标准荷兰医师诊疗模式/标准产前保健应激心理学/预防和控制时间因素女(雌)性人类婴儿新生妊娠

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