DeBusk R F, Miller N H, Superko H R, Dennis C A, Thomas R J, Lew H T, Berger W E, Heller R S, Rompf J, Gee D, Kraemer H C, Bandura A, Ghandour G, Clark M, Shah R V, Fisher L, Taylor C B
Stanford University School of Medicine, CA.
Ann Intern Med. 1994 May 1;120(9):721-9. doi: 10.7326/0003-4819-120-9-199405010-00001.
To evaluate the efficacy of a physician-directed, nurse-managed, home-based case-management system for coronary risk factor modification.
Randomized clinical trial in which patients received a special intervention (n = 293) or usual medical care (n = 292) during the first year after acute myocardial infarction.
5 Kaiser Permanente Medical Centers in the San Francisco Bay area.
585 men and women aged 70 years or younger who were hospitalized for acute myocardial infarction.
In the hospital, specially trained nurses initiated interventions for smoking cessation, exercise training, and diet-drug therapy for hyperlipidemia. Intervention after discharge was implemented primarily by telephone and mail contact with patients in their homes. All medically eligible patients received exercise training; all smokers received the smoking cessation intervention; and all patients received dietary counseling and, if needed, lipid-lowering drug therapy.
Smoking prevalence and plasma low-density lipoprotein cholesterol (LDL) concentrations were measured 2 months after infarction, and functional capacity was measured 6 months after infarction.
In the special intervention and usual care groups, the cotinine-confirmed smoking cessation rates were 70% and 53% (P = 0.03), plasma LDL cholesterol levels were 2.77 +/- 0.69 mmol/L and 3.41 +/- 0.90 mmol/L (107 +/- 30 mg/dL and 132 +/- 30 mg/dL) (P = 0.001), and functional capacities were 9.3 +/- 2.4 METS and 8.4 +/- 2.5 METS (P = 0.001), respectively.
In a large health maintenance organization, a case-management system was considerably more effective than usual medical care for modification of coronary risk factors after myocardial infarction.
评估由医生指导、护士管理的家庭式病例管理系统在改善冠状动脉危险因素方面的疗效。
随机临床试验，患者在急性心肌梗死后的第一年接受特殊干预（n = 293）或常规医疗护理（n = 292）。
旧金山湾区的5家凯撒医疗中心。
585名70岁及以下因急性心肌梗死住院的男性和女性。
在医院里，经过专门培训的护士启动了戒烟、运动训练以及高脂血症饮食药物治疗的干预措施。出院后的干预主要通过电话和邮件与在家中的患者联系来实施。所有符合医学条件的患者都接受了运动训练；所有吸烟者都接受了戒烟干预；所有患者都接受了饮食咨询，必要时还接受了降脂药物治疗。
在梗死2个月后测量吸烟率和血浆低密度脂蛋白胆固醇（LDL）浓度，在梗死6个月后测量功能能力。
在特殊干预组和常规护理组中，经可替宁确认的戒烟率分别为70%和53%（P = 0.03），血浆LDL胆固醇水平分别为2.77±0.69 mmol/L和3.41±0.90 mmol/L（107±30 mg/dL和132±30 mg/dL）（P = 0.001），功能能力分别为9.3±2.4代谢当量和8.4±2.5代谢当量（P = 0.001）。
在一个大型健康维护组织中，病例管理系统在心肌梗死后改善冠状动脉危险因素方面比常规医疗护理有效得多。
