RESUMO
AIM: To assess, through a systematic review, evidence for the effects of antiarrhythmic drugs (AADs) on cardiovascular (CV) hospitalization and mortality. MATERIALS & METHODS: English language articles were identified using MEDLINE, EMBASE and the Cochrane Clinical Trial Registry and were screened for study applicability and methodological quality. RESULTS: Out of 3526 identified studies, 38 were selected for analysis (19 evaluated individual AADs, 13 compared rate- versus rhythm-control strategies, and 6 evaluated multiple AADs but did not report outcomes for individual agents). None of the studies examining individual AADs employed the CV hospitalization end point used in ATHENA (the reference trial). There were no head-to-head comparisons of individual AADs on CV hospitalization. Most high-quality studies used multidrug rate- versus rhythm-control strategies. CONCLUSION: Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence.
Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/mortalidade , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Pesquisa Comparativa da Efetividade , Hospitalização/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoAssuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Gerenciamento Clínico , Qualidade da Assistência à Saúde/economia , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Programas de Assistência Gerenciada/economia , Adesão à Medicação , Pessoa de Meia-Idade , Modelos Teóricos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)'s patient safety portfolio and assess their aggregate potential to contribute to knowledge development. DATA SOURCES: Information abstracted from proposals for projects funded in AHRQ's patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects. STUDY DESIGN: This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the ContextInputProcessProduct model. PRINCIPAL FINDINGS: The 234 projects funded through AHRQ's patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products. CONCLUSIONS: The projects funded in AHRQ's patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Disseminação de Informação , Erros Médicos/prevenção & controle , Educação de Pacientes como Assunto/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Gestão da Segurança/organização & administração , Comportamento Cooperativo , Difusão de Inovações , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Erros Médicos/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Gestão da Qualidade Total/organização & administração , Estados Unidos/epidemiologia , United States Agency for Healthcare Research and QualityRESUMO
OBJECTIVES: To document and assess the experiences of 104 Agency for Healthcare Research and Quality (AHRQ)-funded health information technology (health IT) grantees in planning and implementing health IT systems. DATA SOURCE: Grant proposals and interviews with the AHRQ health IT grantees. DATA COLLECTION METHOD: Extracted descriptive data from the health IT grant proposals; conducted telephone interviews with principal investigators. PRINCIPAL FINDINGS: AHRQ funding of the health IT projects provided important support for health IT development work in various health care settings. Successful implementation required commitment from top management, dedicated staff and financial resources, an open process to encourage buy-in and enthusiasm by end users, and sheer persistence. Technologies required tailoring to the specific organization's needs. Grantees felt their projects could be replicated by others, if organizations had ample IT expertise and resources. Evaluating the value of health IT was hampered by the absence of validated instruments and measures, organizational demands that competed with data collection, and lack of evaluation expertise among health IT implementers. CONCLUSIONS: Experiences of the health IT grantees provide rich information for use by health care providers, AHRQ, and other policy makers to help strengthen future health IT development efforts, including the need to improve evaluation design and standards to assess impact.
Assuntos
Implementação de Plano de Saúde , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Informática Médica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Gestão da Segurança/organização & administração , Tomada de Decisões Gerenciais , Humanos , Erros Médicos/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Gestão da Qualidade Total/organização & administração , Estados Unidos/epidemiologia , United States Agency for Healthcare Research and QualityRESUMO
OBJECTIVE: Evaluate short-term effects of the Patient Safety Improvement Corps (PSIC), an Agency for Healthcare Research and Qualitysponsored program to train state teams in patient safety skills/tools, to assess its contribution to building a national infrastructure supporting effective patient safety practices. DATA SOURCE: Self-reported information gathered from (1) group interviews at the end of each year; (2) individual telephone interviews 1 year later; (3) faxed information forms 2 years later. STUDY DESIGN: Program evaluation of immediate and short-term process and impact (use of skills/tools, information sharing, changes in practice). DATA COLLECTION: Semistructured interviews; faxed forms. PRINCIPAL FINDINGS: One year after training, approximately half of Year 1 and 2 state agency representatives reported they had initiated or modified legislation to strengthen safe practices, and modified adverse event oversight procedures. Approximately three-quarters of hospital representatives said training contributed to modifications to adverse event oversight procedures and promotion of patient safety culture. Two years posttraining, approximately three-quarters of Year 1 trainees said they continued to use many skills/tools. CONCLUSIONS: The PSIC contributed to building a national infrastructure supporting effective patient safety practices. Expanded training is needed to reach a larger fraction of the population for which this training is important.