Hospital Israelita Albert Einstein, São Paulo, Brazil.
Centra Lynchburg General Hospital, Lynchburg, VA.
Int J Qual Health Care. 2020 Apr 21;32(1):A1-A8. doi: 10.1093/intqhc/mzz115.
We aim to examine the effect of benchmarking on quality-of-care metrics in patients presenting with ST-elevation myocardial infarction (STEMI) through the implementation of the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ACTION Registry.
From January 2005 to December 2017, 712 patients underwent primary percutaneous coronary intervention PCI-499 before NCDR ACTION Registry implementation (prior to 2013) and 213 after implementation.
STEMI.
712 patients.
INTERVENTION(S): Primary PCI.
MAIN OUTCOME MEASURE(S): We examined hospital performance for the quality indicators in processes and outcomes of the management of patients presenting with STEMI. Outcome measures include door-to-balloon time (DBT), antiplatelet therapy and anti-ischemic drugs prescribed at discharge from pre-NCDR ACTION Registry to post-implementation.
There was improvement in DBT, decreasing from 94 min in 2012 (before NCDR adoption) to reach a median of 47 min in 2017 (Ptrend < 0.001). The percentage of cases with the optimal DBT of < 90 min increased from 55.8% before to 90.1% after the implementation of the NCDR ACTION Registry (Ptrend < 0.001). The rate of aspirin (90.3-100%, P < 0.001), P2Y12 inhibitor (70.1-78.4%, P = 0.02), beta-blocker (76.8-100%, P < 0.001) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (60.1-99.5%, P < 0.001) prescribed at discharge increased from pre-NCDR ACTION Registry to post-implementation. Adjusted mortality before and after NCDR ACTION Registry implementation showed significant change (from 9.04 to 5.92%; P = 0.027).
The introduction of the ACC NCDR ACTION Registry led to incremental gains in the quality in STEMI management through the benchmarking of process of care and clinical outcomes, achieving reduced DBT, improving guideline-directed medication adherence and increasing patient safety, treatment efficacy and survival.
通过实施美国心脏病学会（ACC）国家心血管数据注册（NCDR）ACTION 注册，研究基准测试对 ST 段抬高型心肌梗死（STEMI）患者护理质量指标的影响。
从 2005 年 1 月至 2017 年 12 月，712 例患者在 NCDR ACTION 注册实施前（2013 年前）接受经皮冠状动脉介入治疗（PCI）-499 例，实施后接受 213 例。
STEMI。
712 例患者。
主要 PCI。
我们检查了在 STEMI 患者管理过程和结果方面的医院绩效质量指标。结果包括门球时间（DBT）、抗血小板治疗和出院时开具的抗缺血药物。从 NCDR ACTION 注册前的 94 分钟（2012 年）降至 2017 年的中位数 47 分钟（趋势<0.001）。DBT 小于 90 分钟的最佳病例百分比从实施 NCDR ACTION 注册前的 55.8%增加到实施后的 90.1%（趋势<0.001）。阿司匹林（90.3-100%，P<0.001）、P2Y12 抑制剂（70.1-78.4%，P=0.02）、β受体阻滞剂（76.8-100%，P<0.001）和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（60.1-99.5%，P<0.001）出院时开具的药物比例从 NCDR ACTION 注册前增加到实施后。实施 NCDR ACTION 注册前后调整后的死亡率发生显著变化（从 9.04%降至 5.92%；P=0.027）。
通过对护理过程和临床结果进行基准测试，引入 ACC NCDR ACTION 注册表在 STEMI 管理质量方面取得了增量收益，实现了 DBT 缩短、改善了指南导向的药物依从性并提高了患者安全性、治疗效果和生存率。
