| Influence of a critical path management tool in the treatment of acute myocardial infarction. Clinical Quality Improvement Network Investigators. | |
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MedLine Citation:
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PMID: 10185975 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The primary objective of this study was to determine the effect of implementing a critical path on use of proven efficacious therapies and outcomes in patients admitted to a hospital with acute myocardial infarction (AMI). The secondary objectives were to evaluate the use of unproven medications and to develop an understanding of the factors associated with adverse in-hospital outcomes in these patients. STUDY DESIGN: A nonrandomized before-after study design was used to evaluate the efficacy of a critical path instrument in patients admitted to hospital with AMI. PATIENTS AND METHODS: Consecutive patients admitted with AMI in nine participating hospitals were enrolled in the study. The critical path instrument consisted of a locally developed, preprinted physician order form. Practice patterns were determined before (n = 2305) and after (n = 2349) implementation of the critical path by primary chart review. Multivariate analysis of risk factors for mortality was performed on a combined database of 6088 AMI patients. RESULTS: The use of acetylsalicylic acid (ASA), nitrates, and beta blockers increased significantly by 3%, 2%, and 9%, respectively, after implementation of the critical path. Use of thrombolytics remained stable at 41%, and calcium channel blocker use decreased significantly by 8%. In-hospital mortality decreased by 1%. There was less use of ASA, nitrates, beta blockers, and thrombolytic therapy in women and the elderly. Multivariate analysis showed that advanced age was associated with increased mortality risk, whereas ASA, beta blockers, nitrates, and calcium channel blockers were associated with reduced mortality risk. CONCLUSION: Implementation of a critical path resulted in increased use of proven efficacious therapies, reduced use of noneffective therapy, and a trend toward reduced mortality. |
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Authors:
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: The American journal of managed care Volume: 4 ISSN: 1088-0224 ISO Abbreviation: Am J Manag Care Publication Date: 1998 Sep |
Date Detail:
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Created Date: 1998-12-03 Completed Date: 1998-12-03 Revised Date: 2005-07-26 |
Medline Journal Info:
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Nlm Unique ID: 9613960 Medline TA: Am J Manag Care Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1243-51 Citation Subset: H |
Affiliation:
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University of Alberta, Edmonton, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use Aged Aspirin / therapeutic use Canada Critical Pathways* Female Humans Male Multivariate Analysis Myocardial Infarction / drug therapy, therapy* Nitrates / therapeutic use Outcome Assessment (Health Care) Patient Selection Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Nitrates; 50-78-2/Aspirin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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