Mehta Rajendra H, Peterson Eric D, Califf Robert M
The Duke Clinical Research Institute, Durham, NC; Duke University Medical Center, Durham, NC 27715, USA.
Am J Med. 2007 May;120(5):398-402. doi: 10.1016/j.amjmed.2006.12.018.
Improved application of existing therapies, directed by evidence-based guidelines, may offer immediate savings of life and function to patients with cardiovascular disease. We sought to evaluate the evidence that use of performance measures derived from clinical practice guidelines is associated with better clinical outcomes in this context. We conducted a search of the MEDLINE database for published studies evaluating the relationship of evidence-based therapies and outcomes in patients with coronary artery disease or heart failure. Studies examined included single-center, regional, national, and international experiences, and varied considerably in design. Most studies linking guidelines-based care to outcomes focused on patients with coronary artery disease; relatively few addressed patients with heart failure. Few studies, all nonrandomized, examined the use of specific interventions to improve quality of care in the context of standardized care tools. Almost all studies showed a strong and "dose-response" association between adherence to guidelines and performance measures and outcomes. Higher quality of care, as documented by better performance based on measures derived from practice guidelines, is associated with improved outcomes in patients with cardiovascular disease.
在循证指南的指导下，更好地应用现有疗法可能会为心血管疾病患者立即节省生命并保留功能。我们试图评估在这种情况下，使用源自临床实践指南的性能指标是否与更好的临床结果相关的证据。我们在MEDLINE数据库中进行了检索，以查找已发表的研究，这些研究评估了循证疗法与冠心病或心力衰竭患者预后之间的关系。所审查的研究包括单中心、地区、国家和国际经验，且设计差异很大。大多数将基于指南的治疗与预后联系起来的研究都集中在冠心病患者身上；涉及心力衰竭患者的相对较少。几乎没有研究（均为非随机研究）在标准化护理工具的背景下考察使用特定干预措施来提高护理质量的情况。几乎所有研究都表明，遵循指南和性能指标与预后之间存在强烈的“剂量反应”关联。根据源自实践指南的指标表现更好所证明的更高护理质量，与心血管疾病患者预后改善相关。
