Duke Clinical Research Institute, Durham, NC.
Duke Clinical Research Institute, Durham, NC.
Am Heart J. 2014 Sep;168(3):398-404. doi: 10.1016/j.ahj.2014.06.007. Epub 2014 Jun 9.
Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over 5 years. The degree to which outpatient providers are controlling risk factors has not been fully described.
We examined adherence to the Million Hearts clinical quality measures using The Guideline Advantage, a nationwide quality improvement program for outpatient care. Specifically, we determined the proportion of patients with (1) ischemic vascular disease who were prescribed an antiplatelet drug; (2) hypertension whose blood pressure was controlled; (3) diabetes mellitus whose most recent low-density lipoprotein cholesterol level was <100 mg/dL; and 4) a tobacco use screening and who received a smoking cessation intervention as needed.
From January 1, 2010, to March 31, 2012, there were 147,038 patients enrolled from 25 US practices. At the practice level, antiplatelet prescription ranged from 50.0% to 82.3% (median 71.9%, interquartile range [IQR] 66.7-82.1), hypertension control ranged from 48.6% to 75.3% (median 66.6%, IQR 60.1-70.9), hyperlipidemia control among patients with diabetes mellitus ranged from 53.3% to 100.0% (median 75.8%, IQR 65.8-83.0), and tobacco use screening and intervention ranged from 31.0% to 98.8% (median 79.8%, IQR 72.0-83.2). Black and people of color races were associated with a lower likelihood of blood pressure control and cholesterol control. Female gender was associated with a lower likelihood of antiplatelet prescription and cholesterol control.
Compliance with quality measures for the Million Hearts initiative varies widely and is notable for racial and gender disparities. Our findings identify multiple opportunities to improve the quality of cardiovascular prevention.
百万心脏计划是一项为期五年旨在预防 100 万例心脏病发作和中风的国家计划。但目前还不完全清楚门诊服务提供者控制风险因素的程度。
我们利用全国性的门诊医疗质量改进计划——“指南优势”（The Guideline Advantage），评估了百万心脏临床质量指标的达标情况。具体来说，我们确定了以下比例：（1）患有缺血性血管疾病并接受抗血小板药物治疗的患者；（2）血压得到控制的高血压患者；（3）最近低密度脂蛋白胆固醇水平<100mg/dL 的糖尿病患者；（4）接受烟草使用筛查并根据需要接受戒烟干预的患者。
从 2010 年 1 月 1 日至 2012 年 3 月 31 日，共有来自 25 家美国诊所的 147038 名患者入组。从诊所层面来看，抗血小板药物处方比例从 50.0%到 82.3%不等（中位数为 71.9%，四分位距[IQR]为 66.7-82.1），高血压控制率从 48.6%到 75.3%不等（中位数为 66.6%，IQR 为 60.1-70.9），患有糖尿病的患者中，血脂控制率从 53.3%到 100.0%不等（中位数为 75.8%，IQR 为 65.8-83.0），烟草使用筛查和干预率从 31.0%到 98.8%不等（中位数为 79.8%，IQR 为 72.0-83.2）。黑人及其他有色人种与血压控制和胆固醇控制的达标率较低有关。女性与抗血小板药物处方和胆固醇控制的达标率较低有关。
百万心脏计划质量指标的达标情况差异很大，存在明显的种族和性别差异。我们的研究结果确定了多个改善心血管预防质量的机会。
