PubMed · 4156400
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M Hamilton. 1974. Hypertension.. https://pubmed.ncbi.nlm.nih.gov/4156400/
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CONTEXT: A rigorous evaluation of continuous quality improvement (CQI) in medical practice has not been carried out on a national scale. OBJECTIVE: To test whether low-intensity CQI interventions can be used to speed the national adoption of 2 coronary artery bypass graft (CABG) surgery process-of-care measures: preoperative beta-blockade therapy and internal mammary artery (IMA) grafting in patients 75 years or older. DESIGN, SETTING, AND PARTICIPANTS: Three hundred fifty-nine academic and nonacademic hospitals (treating 267 917 patients using CABG surgery) participating in the Society of Thoracic Surgeons National Cardiac Database between January 2000 and July 2002 were randomized to a control arm or to 1 of 2 groups that used CQI interventions designed to increase use of the process-of-care measures. INTERVENTION: Each intervention group received measure-specific information, including a call to action to a physician leader; educational products; and periodic longitudinal, nationally benchmarked, site-specific feedback. MAIN OUTCOME MEASURE: Differential incorporation of the targeted care processes into practice at the intervention sites vs the control sites, assessed by measuring preintervention (January-December 2000)/postintervention (January 2001-July 2002) site differences and by using a hierarchical patient-level analysis. RESULTS: From January 2000 to July 2002, use of both process measures increased nationally (beta-blockade, 60.0%-65.6%; IMA grafting, 76.2%-82.8%). Use of beta-blockade increased significantly more at beta-blockade intervention sites (7.3% [SD, 12.8%]) vs control sites (3.6% [SD, 11.5%]) in the preintervention/postintervention (P =.04) and hierarchical analyses (P<.001). Use of IMA grafting also tended to increase at IMA intervention sites (8.7% [SD, 17.5%]) vs control sites (5.4% [SD,15.8%]) (P =.20 and P =.11 for preintervention/postintervention and hierarchical analyses, respectively). Both interventions tended to have more impact at lower-volume CABG sites (for interaction: P =.04 for beta-blockade; P =.02 for IMA grafting). CONCLUSIONS: A multifaceted, physician-led, low-intensity CQI effort can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure.
Copper(II) complexes of carvedilol molecule, (CARVH): 1-[carbazolyl-(4)-oxyl]-3-[(2-methoxyphenoxyethyl)-amino]-2-propanol, were synthesized and characterized with respect to their structural and spectroscopic properties. The crystal structure of [Cu(Carv)Cl(MeOH)](2).4MeOH complex revealed that the molecule chelates two Cu(II) ions via the N and O atoms belonging to the amino and propanol moiety, respectively. The coordination behaviour of carvedilol studied by 1H nuclear magnetic resonance (NMR, 1-D and 2-D-COSY) spectroscopy in dimethyl sulfoxide solution at room temperature, allowed us to obtain structural information and to identify the donor atoms involved in the coordination process in solution.
BACKGROUND: National efforts have focused attention on quality of care, but relatively little is known about whether, and to what extent, improvement has occurred during this recent period. Furthermore, the variability of the recent change over time is not known. METHODS: We sought to determine national and state trends in quality of care for Medicare patients hospitalized with acute myocardial infarction (AMI) between 1994-1995 (n = 234754 discharges) and 1998-1999 (n = 35713 discharges) as part of the Centers for Medicare & Medicaid Services (CMS) National AMI Project. We assessed change in evidence-based, guideline-recommended processes of care. RESULTS: Nationally, among patients without contraindications to therapy, discharge beta-blocker prescription increased by 20.5 percentage points (50.3% to 70.7%); early administration of beta-blocker increased by 17.4 percentage points (51.1% to 68.4%); discharge angiotensin-converting enzyme inhibitor prescription for systolic dysfunction increased by 8.0 percentage points (62.8% to 70.8%); early administration of aspirin increased by 6.6 percentage points (76.4% to 82.9%); and aspirin prescribed at discharge increased by 5.6 percentage points (77.3% to 82.9%) (P<.001 for all categories). Smoking cessation counseling decreased by 3.6 percentage points (40.8% to 37.2%; P<.001). Rates of acute reperfusion therapy did not significantly change (59.2% to 60.6%; P =.35). The median time from hospital arrival to initiation of thrombolytic therapy decreased by 7 minutes (P<.001); and the median time from hospital arrival to initiation of primary percutaneous transluminal coronary angioplasty decreased by 12 minutes (P =.09). CONCLUSIONS: During this 4-year period, quality of care for AMI improved, but substantial variation was observed at both time points. While meaningful population-based improvement has been achieved, ample opportunities for improvement exist. Further work is required to elucidate the strategies associated with improvements in quality of care.