Weingarten S R, Riedinger M S, Conner L, Lee T H, Hoffman I, Johnson B, Ellrodt A G
Cedars-Sinai Medical Center, Department of Medicine, Los Angeles, CA 90048.
Ann Intern Med. 1994 Feb 15;120(4):257-63. doi: 10.7326/0003-4819-120-4-199402150-00001.
The acceptability, safety, and efficacy of practice guidelines have rarely been evaluated. Moreover, despite the recent development of guidelines and decision aids for patients admitted to coronary care and intermediate care units, few have been tested in clinical practice.
A prospective, controlled clinical trial with an alternate-month design.
A large teaching community hospital.
Patients admitted to coronary care and intermediate care units with chest pain who were considered at low risk for complications according to a practice guideline (n = 375).
Physicians caring for patients with chest pain who were at low risk for complications received concurrent, personalized written and verbal reminders regarding a guideline that recommended a 2-day hospital stay.
Use of the practice guideline recommendation with concurrent reminders was associated with a 50% to 69% increase in guideline compliance (P < 0.001) and a decrease in length of stay from 3.54 +/- 4.1 to 2.63 +/- 3.0 days (0.91-day reduction, 95% CI, 0.18 to 1.63; P = 0.02) for all patients with chest pain considered at low risk for complications. The intervention was associated with a total (direct and indirect) cost reduction of $1397 per patient (CI, $176 to $2618; P = 0.03). No significant difference was found in the hospital complication rate between patients admitted to the hospital during control and intervention periods, and no significant difference was noted in complications, patient health status, or patient satisfaction when measured 1 month after hospital discharge.
These results suggest that implementation of this practice guideline through concurrent reminders reduced hospital costs for patients with chest pain considered at low risk for complications. Further study of the guideline is warranted.
实践指南的可接受性、安全性和有效性很少得到评估。此外，尽管最近针对冠心病监护病房和中级护理病房的患者制定了指南和决策辅助工具，但很少有在临床实践中进行测试。
采用隔月设计的前瞻性对照临床试验。
一家大型教学社区医院。
根据实践指南被认为并发症风险较低的冠心病监护病房和中级护理病房的胸痛患者（n = 375）。
负责护理并发症风险较低的胸痛患者的医生同时收到关于一项建议住院2天的指南的个性化书面和口头提醒。
对于所有被认为并发症风险较低的胸痛患者，使用实践指南建议并同时给予提醒与指南依从性提高50%至69%相关（P < 0.001），住院时间从3.54 ± 4.1天减少到2.63 ± 3.0天（减少0.91天，95%CI，0.18至1.63；P = 0.02）。该干预措施使每位患者的总（直接和间接）成本降低了1397美元（CI，176美元至2618美元；P = 0.03）。在对照期和干预期入院的患者之间，医院并发症发生率没有显著差异，出院1个月后在并发症、患者健康状况或患者满意度方面也没有显著差异。
这些结果表明，通过同时提醒实施该实践指南可降低被认为并发症风险较低的胸痛患者的住院成本。有必要对该指南进行进一步研究。
