Peterson Eric D, Albert Nancy M, Amin Alpesh, Patterson J Herbert, Fonarow Gregg C
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
Am J Cardiol. 2008 Sep 8;102(5A):47G-56G. doi: 10.1016/j.amjcard.2008.06.011.
According to several medical registries, there is a need to improve the care of post-myocardial infarction (MI) patients, especially those with left ventricular dysfunction (LVD) and heart failure. This can potentially be achieved by implementing disease management programs, which include critical pathways, patient education, and multidisciplinary hospital teams. Currently, algorithms for critical pathways, including discharge processes, are lacking for post-MI LVD patients. Such schemes can increase the use of evidence-based medicines proved to reduce mortality. Educational programs are aimed at increasing patients' awareness of their condition, promoting medication compliance, and encouraging the adoption of healthy behaviors; such programs have been shown to be effective in improving outcomes of post-MI LVD patients. Reductions in all-cause hospitalizations and medical costs as well as improved survival rates have been observed when a multidisciplinary team (a nurse, a pharmacist, and a hospitalist) is engaged in patient care. In addition, the use of the "pay for performance" method, which can be advantageous for patients, physicians, and hospitals, may potentially improve the care of post-MI patients with LVD.
根据多个医学登记处的数据，有必要改善心肌梗死（MI）后患者的护理，尤其是那些患有左心室功能障碍（LVD）和心力衰竭的患者。这可以通过实施疾病管理计划来实现，该计划包括关键路径、患者教育和多学科医院团队。目前，MI后LVD患者缺乏包括出院流程在内的关键路径算法。这样的方案可以增加已证明能降低死亡率的循证药物的使用。教育计划旨在提高患者对自身病情的认识，促进药物治疗的依从性，并鼓励采取健康行为；此类计划已被证明对改善MI后LVD患者的预后有效。当多学科团队（一名护士、一名药剂师和一名住院医生）参与患者护理时，全因住院率和医疗成本降低，生存率提高。此外，“按绩效付费”方法对患者、医生和医院都可能有利，可能会改善MI后LVD患者的护理。
