Use of critical pathways to improve the care of patients with acute myocardial infarction.
While critical pathways have become a popular strategy to improve the quality of care, their effectiveness is not well defined.
The objective of this study was to investigate the effect of a critical pathway on processes of care and outcomes for Medicare patients admitted with acute myocardial infarction.
SUBJECTS AND METHODS
A retrospective cross-sectional and longitudinal cohort study was made of Medicare patients aged 65 years and older hospitalized at 32 nonfederal Connecticut hospitals with a principal diagnosis of myocardial infarction during two periods : June 1,1992, to February 28,1993, and August 1,1995, to November 30,1995.
The main endpoints of the cross-sectional analyses for the 1995 cohort were the proportion of patients without contraindications who received evidence-based medical therapies, length of stay, and 30-day mortality.
Hospitals with specific critical pathways for patients with myocardial infarction were compared with hospitals without critical pathways.
The main endpoints of the longitudinal analyses were change between 1992-93 and 1995 in the proportion of patients receiving evidence-based medical therapies, length of stay, and 30-day mortality.
Ten hospitals developed critical pathways between 1992-93 and 1995.
Eighteen of 22 nonpathway hospitals employed some combination of standard orders, multidisciplinary teams, or physician champions. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Homme, Assurance qualité, Soin santé primaire, Etats Unis, Amérique du Nord, Amérique, Critère qualité, Rétrospective, Etude cohorte, Hôpital, Mortalité, Délai hospitalisation, Etude comparative, Méthode, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Human, Quality assurance, Primary health care, United States, North America, America, Quality criterion, Retrospective, Cohort study, Hospital, Mortality, Hospitalization delay, Comparative study, Method, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0508886
Code Inist : 002B30A01A1. Création : 22/03/2000.