使用出院工作表可提高对基于证据的心肌梗死护理的依从性。

Use of discharge-worksheet enhances compliance with evidence-based myocardial infarction care.

作者信息

Nori David, Johnson Jeff, Kapke Alissa, Lenk Diane, Borzak Steven, Hudson Michael

机构信息

Henry Ford Hospital Department of Internal Medicine, Detroit, MI 48202, USA.

出版信息

J Thromb Thrombolysis. 2002 Aug;14(1):43-9. doi: 10.1023/a:1022014321328.

DOI:10.1023/a:1022014321328

PMID:12652149

Abstract

BACKGROUND

Prior studies demonstrate that effective secondary prevention therapies are underutilized in patients with myocardial infarction (MI) at hospital discharge. At a US tertiary center, we developed and encouraged providers to complete a simple "Acute MI Discharge Worksheet" (MIDW) designed to educate patients, prompt caregivers, and provide chart documentation regarding evidence-based therapies post-MI.

METHODS AND RESULTS

The MIDW was introduced in May of 2000 with use encouraged in all surviving patients with MI. We calculated a patient discharge score by summing the number of quality indicators (aspirin use, beta-blocker use, ACE-inhibitor use, smoking cessation, lipid-lowering therapy, cardiac rehabilitation referral) and compared documentation of quality indicators at discharge between patients without (Group I, n = 65) and with (Group II, n = 60) the MIDW. Group II was subdivided into those with an incomplete worksheet (Group IIa, n = 26), and those with a completed worksheet (Group IIb, n = 34). Greater documentation of secondary prevention indicators occurred in patients with incomplete and completed discharge forms present. Mean Discharge scores were significantly higher for Group II vs. Group I (4.98 vs. 3.88, p < 0.0001), and Group IIb vs. Group IIa, (5.47 vs. 4.35, p < 0.001).

CONCLUSION

A simple "Acute MI Discharge Worksheet" was associated with better adherence and documentation of evidence-based post MI care and be a useful component to improve post MI care.

摘要

背景

先前的研究表明，心肌梗死（MI）患者出院时有效的二级预防治疗未得到充分利用。在美国一家三级医疗中心，我们开发并鼓励医疗服务提供者填写一份简单的“急性心肌梗死出院工作表”（MIDW），旨在对患者进行教育，提醒护理人员，并提供有关心肌梗死后循证治疗的病历记录。

方法与结果

2000年5月引入MIDW，并鼓励所有存活的心肌梗死患者使用。我们通过对质量指标（阿司匹林使用、β受体阻滞剂使用、ACE抑制剂使用、戒烟、降脂治疗、心脏康复转诊）的数量进行求和来计算患者出院评分，并比较了未使用MIDW的患者（第一组，n = 65）和使用MIDW的患者（第二组，n = 60）出院时质量指标的记录情况。第二组又细分为工作表填写不完整的患者（第二组a，n = 二十六）和工作表填写完整的患者（第二组b，n = 34）。在有不完整和完整出院表格的患者中，二级预防指标的记录更多。第二组的平均出院评分显著高于第一组（4.98对3.88，p < 0.0001），第二组b高于第二组a（5.47对4.35，p < 0.001）。