OUTCOMES OF COMPLIANCE WITH AN AMI PRACTAICE GUIDELINE

遵守 AMI 实践指南的结果

• 批准号: 2236155
• 负责人: STEPHEN B SOUMERAI
• 金额: $ 46.82万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-12-01 至 1997-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2236155
• 关键词: OUTCOMES; COMPLIANCE; AMI; PRACTAICE; GUIDELINE

The proposed research will investigate: (1) whether will-documented treatment guidelines, which could result in improved survival and reduced re-hospitalization in post-myocardial infarction patients, are being adopted by physicians in primary care settings; and (2) whether a retrospective cohort study using large, linked Medicare and two state drug-claims data bases (N=9,600 AMI patients) can replicate the results of randomized controlled trials (RCTs) of beta blocker therapy on patient outcomes. Several large RCTs have already confirmed the value of chronic beta blockade following AMI in increasing survival and reducing the risks and costs of post-AMI cardiac events. Two-year mortality rates and rates of non-fatal reinfarctions appear to be 20-40% lower in patients receiving long-term beta blockade. Yet, few data exist from large, "real-world" populations on the predictors and outcomes of use of these effective agents, particularly among women, minorities, and elderly people, who are well-represented in this study. The investigators will link and analyze three New Jersey claims data- bases in their possession, including eight years of Medicare claims data, computer drug claims data for poor elderly Medicaid patients (n=about 60,000/yr), and for moderate-income elderly enrollees in a state drug benefit program for the elderly (n= about 250,000/yr). Specific research questions include (but are not limited to): 1. What proportion of eligible elderly patients with first AMIs (that is, those without known contraindications) receive beta blockers after AMI? 2. What proportion of such patients receive these medications on a regular basis? 3. Has the publication of numerous clinical reports in the mid-1980s recommending beta blocker therapy routinely after AMI increased utilization over time (1986-92)? 4. Do patient characteristics (e.g., age, sex, race, income, Medicaid vs. non-Medicaid, prior AMI) predict use of beta blockers after AMI? 5. Do specific physician characteristics (e.g., cardiovascular specialty, group practice) predict higher rates of appropriate use of beta blockers for eligible patients? 6. Using survival analysis methodologies which control for all patient and physician characteristics predicting use of beta blockers, what are the estimated effects of post-AMI beta blocker therapy on the rate of reinfarctions and survival? Are claims-based epidemiological estimates similar to results reported in large RCTs?

拟议的研究将调查：（1）是否有记录 治疗指南，这可能会改善生存和减少 心肌梗塞后患者的重新住院 由医生在初级保健环境中采用； （2）是否a 回顾性队列研究使用大型的，链接的Medicare和两个状态 药物寻求数据库（n = 9,600名AMI患者）可以复制结果 Beta阻滞剂治疗的随机对照试验（RCT） 结果。 几个大RCT已经确认了慢性β的值 AMI封锁以增加生存并降低风险和 AMI后心脏事件的成本。 两年的死亡率和率 接收的患者的非致命恢复似乎降低了20-40％ 长期Beta封锁。 但是，很少有来自大型“现实世界”的数据 这些有效的预测因素和结果的种群 代理人，特别是在妇女，少数民族和老年人中 在这项研究中有很好的代表。 调查人员将链接和分析三个新泽西州索赔数据 - 他们拥有的基础，包括八年的Medicare索赔数据， 计算机药物要求贫穷的老年医疗补助患者的数据（n =大约 60,000/yr），适用于中等收入的国家药物 老年人的福利计划（n =约250,000/年）。 具体研究 问题包括（但不限于）：1。 符合条件的老年患者（即那些没有已知的人） 禁忌症）在AMI之后会收到β受体阻滞剂吗？ 2。比例 在此类患者中，定期接受这些药物？ 3 1980年代中期的众多临床报告的出版 在AMI增加后，通常建议Beta阻滞剂治疗 随着时间的推移利用（1986-92）？ 4。做患者特征（例如， 年龄，性别，种族，收入，医疗补助与非医疗服务，先前AMI）预测使用 AMI之后的Beta阻滞剂？ 5。做特定的医师特征 （例如，心血管专业，小组实践）预测 适当使用合格患者的β受体阻滞剂？ 6。使用 生存分析方法控制所有患者和 医师特征可以预测使用β受体阻滞剂的使用，什么是 后AMI Beta阻滞剂治疗对率的估计影响 恢复和生存？ 是基于索赔的流行病学估计值 类似于大型RCT报告的结果？