Background: Research is needed to validate effective and practical strategies for improving the provision of evidence-based medicine in primary care. Objective: To determine whether a multimethod quality improvement i...Background: Research is needed to validate effective and practical strategies for improving the provision of evidence-based medicine in primary care. Objective: To determine whether a multimethod quality improvement intervention was more effective than a less intensive intervention for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke. Design: 2-year randomized, controlled clinical trial with the practice as the unit of randomization. Setting: 20 community-based family or general internal medicine practices in 14 states. All used the same electronic medical record. Participants: 44 physicians, 17 midlevel provi-ders, and approximately 200 staff members; data from the electronic medical records of 87 291 patients. Interventions: All practices received copies of practice guidelines and quarterly performance reports. Intervention practices also hosted quarterly site visits to help them adopt quality improvement approaches and participated in 2 network meetings to share "best practice"approaches. Measurements: The percentage of indicators at or above predefined targets and the percentage of patients who had achieved each clinical indicator. Results: Intervention practices improved 22.4 percentage points (from 11.3%to 33.7%) in the percentage of indicators at or above the target; control practices improved 16.4 percentage points (from 6.3%to 22.7%). The 6.0-percentage point absolute difference between the intervention and control group was not statistically significant (P >0.2). Patients in intervention practices had greater improvements than those in control practices for diagnoses of hypertension(improve-ment difference, 15.7 percentage points [95%CI, 5.2 to 26.3 percentage points]) and blood pressure control in patients with hypertension (improvement difference, 8.0 percentage points [CI, 0.0 to 16.0 percentage points]). Limitations: The study involved a small number of practices and lacked a pure control group. Conclusions: Primary care practices that use electronic medical records and receive regular performance reports can improve their adherence to clinical practice guidelines for cardiovascular disease and stroke prevention.展开更多
对基因功能的了解和基因测序技术的进步,为实施个体化医疗提供了先决条件。利用基因特点选择药物,并将药物以最适的剂量、最适的时间用于最适的人群,从而使药物疗效最大化,不良反应(adverse drug reactions,ADR)最小化。药物基因组学(ph...对基因功能的了解和基因测序技术的进步,为实施个体化医疗提供了先决条件。利用基因特点选择药物,并将药物以最适的剂量、最适的时间用于最适的人群,从而使药物疗效最大化,不良反应(adverse drug reactions,ADR)最小化。药物基因组学(pharmacogenomics,PGx)是通过研究基因组变异在药物药代动力学和药效学中的作用,为个性化用药提供方案。本文将重点综述目前PGx在不同心血管药物中的临床研究进展,进而为PGx指导心血管治疗提供更多的临床证据。展开更多
文摘Background: Research is needed to validate effective and practical strategies for improving the provision of evidence-based medicine in primary care. Objective: To determine whether a multimethod quality improvement intervention was more effective than a less intensive intervention for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke. Design: 2-year randomized, controlled clinical trial with the practice as the unit of randomization. Setting: 20 community-based family or general internal medicine practices in 14 states. All used the same electronic medical record. Participants: 44 physicians, 17 midlevel provi-ders, and approximately 200 staff members; data from the electronic medical records of 87 291 patients. Interventions: All practices received copies of practice guidelines and quarterly performance reports. Intervention practices also hosted quarterly site visits to help them adopt quality improvement approaches and participated in 2 network meetings to share "best practice"approaches. Measurements: The percentage of indicators at or above predefined targets and the percentage of patients who had achieved each clinical indicator. Results: Intervention practices improved 22.4 percentage points (from 11.3%to 33.7%) in the percentage of indicators at or above the target; control practices improved 16.4 percentage points (from 6.3%to 22.7%). The 6.0-percentage point absolute difference between the intervention and control group was not statistically significant (P >0.2). Patients in intervention practices had greater improvements than those in control practices for diagnoses of hypertension(improve-ment difference, 15.7 percentage points [95%CI, 5.2 to 26.3 percentage points]) and blood pressure control in patients with hypertension (improvement difference, 8.0 percentage points [CI, 0.0 to 16.0 percentage points]). Limitations: The study involved a small number of practices and lacked a pure control group. Conclusions: Primary care practices that use electronic medical records and receive regular performance reports can improve their adherence to clinical practice guidelines for cardiovascular disease and stroke prevention.
文摘对基因功能的了解和基因测序技术的进步,为实施个体化医疗提供了先决条件。利用基因特点选择药物,并将药物以最适的剂量、最适的时间用于最适的人群,从而使药物疗效最大化,不良反应(adverse drug reactions,ADR)最小化。药物基因组学(pharmacogenomics,PGx)是通过研究基因组变异在药物药代动力学和药效学中的作用,为个性化用药提供方案。本文将重点综述目前PGx在不同心血管药物中的临床研究进展,进而为PGx指导心血管治疗提供更多的临床证据。
