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提高对他汀类药物处方指南的认识:一项质量改进项目。

Improving provider awareness to statin prescribing guidelines: A quality improvement project.

机构信息

University of Alabama at Birmingham, Atlanta, Georgia.

University of Alabama at Birmingham, Rock Spring, Georgia.

出版信息

J Vasc Nurs. 2020 Mar;38(1):25-28. doi: 10.1016/j.jvn.2019.11.001. Epub 2019 Dec 26.

Abstract

Guidelines recommend statin therapy for all patients with peripheral artery disease (PAD) due to the increased risk of adverse cardiovascular events. A lack of adherence to these guidelines was identified at a vascular clinic located in the southeastern United States. The aim of this nurse practitioner-led quality improvement project was to increase the percentage of patients with lower extremity PAD who were prescribed a statin medication at this clinic. Baseline data were obtained via a chart review. Using the Plan-Do-Study-Act (PDSA) model, a paper tool depicting an evidence-based algorithm was implemented in the clinic for 6 weeks to increase awareness of guidelines (PDSA cycle 1). Next, an electronic pop-up reminder was implemented in the electronic health record for the following 6 weeks (PDSA cycle 2). Data were collected throughout the process and analyzed to determine if either intervention increased the number of patients with PAD who were prescribed a statin medication. Baseline data revealed only 54.16% of patients were on a statin medication. After PDSA cycle 1, an average of 70.8% of patients were on a statin medication. PDSA cycle 2 revealed an average of 73.3% of patients were taking a statin medication. ANOVA was conducted and showed statistical significance between the groups (P = .003). There was statistical significance between baseline and implementation of the algorithm and baseline and implementation of the pop-up, but not between the 2 interventions. These findings are consistent with research suggesting algorithms and electronic reminders may increase medical staff awareness of guidelines. Standardization of these interventions enhanced provider adherence to guidelines and ultimately improved patient outcomes.

摘要

指南建议所有外周动脉疾病(PAD)患者使用他汀类药物治疗,因为这些患者发生不良心血管事件的风险增加。在美国东南部的一家血管诊所发现,患者对这些指南的依从性较差。该护士从业者主导的质量改进项目旨在提高该诊所下肢 PAD 患者开具他汀类药物的比例。通过病历回顾获得基线数据。使用计划-执行-研究-行动(PDSA)模型,在诊所实施了一个为期 6 周的描述循证算法的纸质工具,以提高对指南的认识(PDSA 循环 1)。接下来,在电子健康记录中实施了为期 6 周的电子弹出式提醒(PDSA 循环 2)。在整个过程中收集数据并进行分析,以确定这两种干预措施是否增加了开具他汀类药物的 PAD 患者数量。基线数据显示,只有 54.16%的患者正在服用他汀类药物。在 PDSA 循环 1 之后,平均有 70.8%的患者正在服用他汀类药物。PDSA 循环 2 显示,平均有 73.3%的患者正在服用他汀类药物。进行方差分析显示,组间有统计学意义(P=0.003)。在实施算法和弹出式提醒前后与基线相比,均具有统计学意义,但在两种干预措施之间没有统计学意义。这些发现与研究结果一致,研究表明算法和电子提醒可能会提高医务人员对指南的认识。这些干预措施的标准化增强了提供者对指南的依从性,最终改善了患者的结局。

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