Simpson R J, Sueta C A, Boccuzzi S J, Lulla A, Biggs D, Londhe A, Smith S C
Medical Review of North Carolina, Cary 27627, USA.
Am J Cardiol. 1997 Oct 30;80(8B):53H-56H. doi: 10.1016/s0002-9149(97)00821-7.
The Agency for Health Care Policy and Research, the National Heart Lung and Blood Institute of the National Institutes of Health, the American Heart Association, and the American College of Cardiology have all developed guidelines for improving the care of patients with cardiovascular disease. The guidelines include recommendations for intensive lipid-lowering therapy in patients with coronary artery disease (CAD) and angiotensin-converting enzyme (ACE) inhibitors in those patients with symptomatic heart failure and asymptomatic left ventricular dysfunction. Despite clinical trial evidence and consensus that these therapies improve survival in high-risk patients, data suggest that there is wide variation in the delivery of guideline-based care. To investigate whether evidence-based assessment of provider practice patterns can impact the delivery of quality cost-effective care, Merck and Company, in conjunction with leading cardiology group practices, the University of North Carolina at Chapel Hill, and Medical Review of North Carolina developed an ambulatory medical record abstraction study. This quality assurance initiative was conducted at practices beginning in the spring of 1996 and continues. Medical records and administrative claims of patients with ischemic heart disease or heart failure were abstracted by a healthcare consulting organization to maintain patient and physician confidentiality. As of mid-July 1997, 626 group practices had completed the medical record abstraction process, with > 1,136 practices participating at some stage of the project; >6,000 physicians participated in the project and >270,000 patients charts were abstracted. Analysis of these data will provide insight and benchmark patterns of care in the pharmacologic management of heart failure and CAD. This project represents a unique collaboration between a pharmaceutical company, an academic institution, a Peer Review Organization, and practicing physicians, to support evidence-based best medical practices.
医疗保健政策与研究机构、国立卫生研究院的国家心肺血液研究所、美国心脏协会以及美国心脏病学会都制定了改善心血管疾病患者护理的指南。这些指南包括对冠状动脉疾病（CAD）患者进行强化降脂治疗的建议，以及对有症状心力衰竭和无症状左心室功能障碍患者使用血管紧张素转换酶（ACE）抑制剂的建议。尽管有临床试验证据和共识表明这些疗法可提高高危患者的生存率，但数据显示基于指南的护理实施存在很大差异。为了调查对医疗服务提供者实践模式进行循证评估是否会影响优质且具成本效益的护理的提供，默克公司与领先的心脏病学团体实践机构、北卡罗来纳大学教堂山分校以及北卡罗来纳医学审查机构联合开展了一项门诊病历摘要研究。这项质量保证计划于1996年春季在各实践机构启动并持续进行。一家医疗咨询机构提取了缺血性心脏病或心力衰竭患者的病历和行政索赔信息，以保护患者和医生的隐私。截至1997年7月中旬，626个团体实践机构完成了病历摘要过程，超过1136个实践机构在项目的某个阶段参与其中；超过6000名医生参与了该项目，超过27万份患者病历被提取。对这些数据的分析将为心力衰竭和CAD药物治疗中的护理模式提供见解和基准。该项目代表了一家制药公司、一个学术机构、一个同行评审组织和执业医生之间的独特合作，以支持循证最佳医疗实践。
