Birkhead J S, Walker L, Pearson M, Weston C, Cunningham A D, Rickards A F
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
Heart. 2004 Sep;90(9):1004-9. doi: 10.1136/hrt.2004.034470.
To describe the improvements in care that have followed the introduction of an electronic data entry and analysis system providing contemporary feedback on the management of acute coronary syndromes in 230 hospitals in England and Wales.
Observational study
A secure electronic system was used to transfer encrypted data on patients with acute coronary syndromes from collaborating hospitals to central servers for analysis. Immediate online data entry to the central servers by hospitals allowed contemporary analyses of performance and immediate comparison with the national aggregate performance.
The records of 156 902 patients receiving a final diagnosis of acute coronary syndrome during three years between October 2000 and September 2003 were analysed. Of 69 113 patients with ST segment elevation infarction, 75.4% received thrombolytic treatment. Between the first and last years of the study the median interval from hospital arrival to treatment fell for eligible patients from 38 (interquartile range 22-58) to 20 (interquartile range 14-28) minutes. By mid 2003 77.6% were receiving thrombolytic treatment within 30 minutes of arrival. The proportion treated within two hours of onset of symptoms increased from 32.5% to 40.3% (a difference of 7.8 percentage points, p < 0.0001). The use of secondary prevention medication for acute coronary syndromes increased over this period: angiotensin converting enzyme inhibitors, 62.4% to 72.4%; beta blockers, 76.3% to 82.6%; statins, 69.6% to 83.8%; and aspirin, 89.3% to 90.2%.
The provision of contemporary online performance analyses has underpinned substantial improvement in the care of patients with acute coronary syndromes.
描述在英格兰和威尔士的230家医院引入一个提供急性冠脉综合征管理实时反馈的电子数据录入与分析系统后护理方面的改善情况。
观察性研究
使用一个安全的电子系统将急性冠脉综合征患者的加密数据从合作医院传输到中央服务器进行分析。医院可立即在线向中央服务器录入数据，从而对性能进行实时分析，并与全国总体性能进行即时比较。
分析了2000年10月至2003年9月这三年间最终诊断为急性冠脉综合征的156902例患者的记录。在69113例ST段抬高型心肌梗死患者中，75.4%接受了溶栓治疗。在研究的第一年和最后一年之间，符合条件的患者从入院到治疗的中位间隔时间从38分钟（四分位间距22 - 58分钟）降至20分钟（四分位间距14 - 28分钟）。到2003年年中，77.6%的患者在到达后30分钟内接受了溶栓治疗。症状发作两小时内接受治疗的比例从32.5%增至40.3%（相差7.8个百分点，p < 0.0001）。在此期间，急性冠脉综合征二级预防药物的使用有所增加：血管紧张素转换酶抑制剂从62.4%增至72.4%；β受体阻滞剂从76.3%增至82.6%；他汀类药物从69.6%增至83.8%；阿司匹林从89.3%增至90.2%。
提供实时在线性能分析为急性冠脉综合征患者护理的显著改善提供了支持。
