Improving Compliance with AMI Practice Guidelines. Abstract and Executive Summary

摘要

The selection of therapeutic interventions for acute myocardial infarction (AMI)211u001epatients is a critical medical decision. Studies have shown that some drug 211u001etreatments for AMI reduce mortality, but others appear to be harmful when used 211u001eroutinely. Despite the existence of evidence-based guidelines for treatment of 211u001epatients with AMI, few studies have examined the rates of adherence these 211u001eguidelines and the reasons for nonadherence. This randomized controlled trial 211u001ereviewed medical records, 2,400 AMI patients admitted to Minnesota hospitals to 211u001edetermine what proportion of patients received medical therapies that have proven 211u001eto be effective, and what proportion received potentially harmful treatments. 211u001eInvestigators then focused on reasons for departure from guidelines, and on what 211u001ethe principal barriers are to physician acceptance of guidelines. Several other 211u001eresearch questions were addressed as well. Investigators identified opinion 211u001eleaders at 20 hospitals who influenced peers through group discussions and 211u001econsultations ('opinion leader guideline interventions dissemination'), and 211u001eassessed their effect on quality of care for AMI. They measured the use of life-211u001esaving therapies for AMI patients before and after the implementation of 211u001erandomized, local opinion leader guideline dissemination intervention and found 211u001esignificant improvements in quality of care after the intervention.