Basoor Abhijeet, Doshi Nitin C, Cotant John F, Saleh Tarek, Todorov Mina, Choksi Nishit, Patel Kiritkumar C, Degregorio Michele, Mehta Rajendra H, Halabi Abdul R
Division of Cardiology, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA.
Congest Heart Fail. 2013 Jul-Aug;19(4):200-6. doi: 10.1111/chf.12031.
Providing effective discharge instructions, appropriate dose uptitration, education regarding heart failure (HF) monitoring, and strict follow-up have all been shown to decrease readmissions for HF but are all underutilized. The authors developed and evaluated the impact of a quality-improvement HF checklist as a tool to remind physicians to improve quality of care in HF patients. The checklist was used in randomly selected patients admitted with a primary diagnosis of acute decompensated HF. It included documentation regarding medications and dose uptitration, relevant counseling, and follow-up instructions at discharge. The checklist was used in 48 patients, and this checklist group was compared with 48 patients as a randomly selected control group. Higher proportions of patients were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in the checklist group compared with the control group (40 of 48 vs 23 of 48, P<.001). Compared with the controls, the rate of dose uptitration for β-blockers and/or ACE inhibitors/ARBs was more common in the checklist group (4 of 48 vs 21 of 48, P<.001). Both 30-day (19% to 6%) and 6-month (42% to 23%) readmissions were lower in the checklist group. The use of an HF checklist was associated with better quality of care and decreased readmission rates for patients admitted with HF.
提供有效的出院指导、适当的剂量滴定、关于心力衰竭（HF）监测的教育以及严格的随访，均已被证明可降低HF患者的再入院率，但这些措施都未得到充分利用。作者开发并评估了一份心力衰竭质量改进检查表的影响，该检查表作为一种工具，可提醒医生提高HF患者的护理质量。该检查表用于随机选择的以急性失代偿性HF为主要诊断入院的患者。它包括有关药物和剂量滴定的记录、相关咨询以及出院时的随访指导。该检查表应用于48例患者，并将该检查表组与随机选择的48例患者作为对照组进行比较。与对照组相比，检查表组中服用血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）的患者比例更高（48例中的40例 vs 48例中的23例，P<0.001）。与对照组相比，检查表组中β受体阻滞剂和/或ACE抑制剂/ARB的剂量滴定率更常见（48例中的4例 vs 48例中的21例，P<0.001）。检查表组的30天（19%至6%）和6个月（42%至23%）再入院率均较低。使用HF检查表与更好的护理质量以及降低HF入院患者的再入院率相关。
