CONTEXT: A decision-support tool was created to identify opportunities to improve outcomes for patients with coronary artery disease and heart failure by delivering all efficacious interventions; that is, "optimizing" care. When national data were applied, nearly 75% of the deaths that could be prevented or postponed by optimizing care for patients with heart disease would occur among ambulatory patients. OBJECTIVE: The purpose of this analysis is two-fold: 1) to determine whether medical group data are adequate to use in the decision-support tool, and 2) to determine whether the conclusions generated from the medical group data are similar to the conclusions generated from US data. DESIGN/MAIN OUTCOME MEASURE: The potential impact of optimizing care for patients age 40 to 75 years treated for coronary artery disease and heart failure by a multispecialty group between August 2007 and July 2008 was calculated using deaths that might be prevented or postponed if optimal care was achieved. RESULTS: The greatest opportunity to prevent or postpone deaths-70% of the total opportunity-lies with optimizing care for ambulatory patients. Optimizing care for patients hospitalized for acute myocardial infarction with or without ST-segment elevation on electrocardiography would prevent or postpone only 2% of deaths. CONCLUSIONS: This study demonstrates that 1) it is feasible to use the decision-support tool to analyze opportunities for improvement in a medical group, and 2) as concluded from national data analysis, optimizing ambulatory care presents the greatest opportunity to improve outcomes for patients with heart disease.
CONTEXT: A decision-support tool was created to identify opportunities to improve outcomes for patients with coronary artery disease and heart failure by delivering all efficacious interventions; that is, "optimizing" care. When national data were applied, nearly 75% of the deaths that could be prevented or postponed by optimizing care for patients with heart disease would occur among ambulatory patients. OBJECTIVE: The purpose of this analysis is two-fold: 1) to determine whether medical group data are adequate to use in the decision-support tool, and 2) to determine whether the conclusions generated from the medical group data are similar to the conclusions generated from US data. DESIGN/MAIN OUTCOME MEASURE: The potential impact of optimizing care for patients age 40 to 75 years treated for coronary artery disease and heart failure by a multispecialty group between August 2007 and July 2008 was calculated using deaths that might be prevented or postponed if optimal care was achieved. RESULTS: The greatest opportunity to prevent or postpone deaths-70% of the total opportunity-lies with optimizing care for ambulatory patients. Optimizing care for patients hospitalized for acute myocardial infarction with or without ST-segment elevation on electrocardiography would prevent or postpone only 2% of deaths. CONCLUSIONS: This study demonstrates that 1) it is feasible to use the decision-support tool to analyze opportunities for improvement in a medical group, and 2) as concluded from national data analysis, optimizing ambulatory care presents the greatest opportunity to improve outcomes for patients with heart disease.
Authors: Rod S Taylor; Allan Brown; Shah Ebrahim; Judith Jolliffe; Hussein Noorani; Karen Rees; Becky Skidmore; James A Stone; David R Thompson; Neil Oldridge Journal: Am J Med Date: 2004-05-15 Impact factor: 4.965
Authors: Earl S Ford; Umed A Ajani; Janet B Croft; Julia A Critchley; Darwin R Labarthe; Thomas E Kottke; Wayne H Giles; Simon Capewell Journal: N Engl J Med Date: 2007-06-07 Impact factor: 91.245