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Lost in translation: health resource variability in the achievement of optimal performance and clinical outcome.
- Source :
-
Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2011 Sep; Vol. 4 (5), pp. 512-20. Date of Electronic Publication: 2011 Aug 30. - Publication Year :
- 2011
-
Abstract
- BACKGROUND- An evidence-practice gap in acute coronary syndromes (ACS) is commonly recognized. System, provider, and patient factors can influence guideline adherence. Through using guideline facilitators in the clinical setting, the uptake of evidence-based recommendations may be increased. We hypothesized that facilitators of guideline recommendations (systems, tools, and workforce) in acute cardiac care were associated with increased guideline adherence and decreased adverse outcome. METHODS AND RESULTS- A cross-sectional evaluation of guideline facilitators was conducted in Australian hospitals. The population was derived from the Acute Coronary Syndrome Prospective Audit (ACACIA) and assessed performance, death, and recurrent myocardial infarction (death/re-MI) at 30 days and 12 months. Thirty-five hospitals and 2392 patients participated. Significant associations with decreased death/re-MI were observed with hospital strategies to facilitate primary percutaneous coronary intervention for ST-elevation MI patients (38/428 [8.9%] versus 30/154 [19.5%], P<0.001) and after adjustment (odds ratio [OR], 0.47 [95% confidence interval (CI), 0.24 to 0.90], P<0.023), electronic discharge checklists (none: 233/1956 [11.9%], integrated; 43/251[17.1%], P=0.069, electronic; 6/124 [4.8%], P<0.001) and after adjustment (integrated versus none: OR, 1.66 [95% CI, 0.98 to 2.80], P=0.057 and electronic versus none: OR, 0.49 [95% CI, 0.35 to 0.68], P<0.001), and intensive cardiac care unit (ICCU) staff-to-patient ratios (neither: 200/1257 (15.9%), CCU: 135/1051 (12.8%), ICCU: 8/84 (9.5%), P=0.049 and after adjustment (CCU versus neither: OR, 0.74 [95% CI, 0.47 to 1.14], P=0.172 and ICCU versus neither: OR, 0.55; [95% CI, 0.38 to 0.81] P=0.003). CONCLUSIONS- Facilitating uptake of evidence in clinical practice may need to consider quality improvement systems, tools and workforce to achieve optimal ACS outcomes.
- Subjects :
- Acute Coronary Syndrome mortality
Acute Coronary Syndrome therapy
Angioplasty standards
Australia
Coronary Care Units statistics & numerical data
Evidence-Based Medicine trends
Follow-Up Studies
Guideline Adherence
Humans
Practice Guidelines as Topic
Risk Adjustment
Survival Analysis
Translational Research, Biomedical
Treatment Outcome
Acute Coronary Syndrome economics
Acute Coronary Syndrome epidemiology
Angioplasty statistics & numerical data
Health Resources statistics & numerical data
Hospitals
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 4
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 21878668
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.110.960229