Effect of local medical opinion leaders on quality of care for acute myocardial infarction a randomized controlled trial.
Context. - The effectiveness of recruiting local medical opinion leaders to improve quality of care is poorly understood.
- To evaluate a guideline-implementation intervention of clinician education by local opinion leaders and performance feedback to (1) increase use of lifesaving drugs (aspirin and thrombolytics in eligible elderly patients, bêta-biockers in all eligible patients) for acute myocardial infarction (AMI), and- (2) decrease use of a potentially harmful therapy (prophylactic lidocaine).
- Randomized controlled trial with hospital as the unit of randomization, intervention, and analysis.
- Thirty-seven community hospitals in Minnesota.
- All patients with AMI admitted to study hospitals over 10 months before (1992-1993, N=2409) or after (1995-1996, N=2938) the intervention.
Intervention-Using a validated survey, we identified-opinion leaders at 20 experimental hospitals who influenced peers through small and large group discussions, informal consultations, and revisions of protocols and dinical pathways.
They focused on (1) evidence (drug efficacy), (2) comparative performance, and (3) barriers to change.
Control hospitals received mailed performance feedback.
Main Outcome Measures
- Hospital-specific changes before and after the intervention in the proportion of eligible-patients receiving each study drug. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Qualité, Soin, Protocole thérapeutique, Opinion publique, Médecin, Etats Unis, Amérique du Nord, Amérique, Traitement, Influence, Randomisation, Homme, Vieillard, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Leader
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Quality, Care, Therapeutic protocol, Public opinion, Physician, United States, North America, America, Treatment, Influence, Randomization, Human, Elderly, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0261407
Code Inist : 002B30A01C. Création : 11/09/1998.