QI vs Research Where do we draw the line Yale 齐与研究我们画线耶鲁.pptVIP

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QI vs Research Where do we draw the line Yale 齐与研究我们画线耶鲁.ppt

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QI vs Research Where do we draw the line Yale 齐与研究我们画线耶鲁

Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Brigadier General Telford Taylor offers the opening statement for the prosecution. Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * Dr. Sandra Alfano October 23, 2008 * BACKGROUND: Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time. METHODS: We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time. RESULTS: In multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a cent