Lehrmann Jill F, Tanabe Paula, Baumann Brigitte M, Jones Molly K, Martinovich Zoran, Adams James G
Department of Emergency Medicine, Northwestern University, Chicago, IL, USA.
Acad Emerg Med. 2007 Nov;14(11):1090-6. doi: 10.1197/j.aem.2007.05.016. Epub 2007 Sep 26.
To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure.
Two academic centers implemented a pre-post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were abstracted from the medical record. The policy was disseminated after the initial medical record review. Post-policy dissemination medical record review was conducted within two weeks.
A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post).
Knowledge of guidelines did not translate into changes in physician practice. Additional systems-based approaches are necessary to effectively translate guidelines into clinical practice.
确定向急诊医生传播美国急诊医师学会关于高血压的临床政策是否会改善对血压的重新评估以及对急诊科（ED）血压升高患者的转诊情况。
两个学术中心采用干预前后设计，在干预前和干预后阶段设置独立样本。急诊部工作人员对调查不知情。在政策传播前共审查了377份病历，政策传播后审查了402份病历。如果患者年龄至少18岁、未怀孕、从急诊部出院且分诊收缩压≥140 mmHg或舒张压≥90 mmHg，则其病历符合审查条件。主要主诉为胸痛、呼吸急促或神经系统症状的患者病历被排除。从病历中提取人口统计学信息、血压以及出院转诊证据。在首次病历审查后传播该政策。在政策传播后两周内进行病历审查。
共审查了779份病历。患者的平均年龄为45岁，55%为男性，46%为白人，13%为西班牙裔，35%为非裔美国人，6%为其他种族。研究阶段之间在重新评估率或转诊率方面未发现差异。两个阶段的血压重新评估率都很低：干预前为33%，干预后为37%。血压升高患者的转诊率非常低：干预前为13%，干预后为7%。
指南知识并未转化为医生行为的改变。需要额外的基于系统的方法来有效地将指南转化为临床实践。
