enough after heart attacks, study finds
Although it is well documented that using beta blockers 1is effective in preventing a subsequent heart attack or death, a study by Yale researchers concludes that not all hospitals are prescribing them widely for complicated internal reasons.
B-blockers slow the heart rate. The American Medical Association has reminded physicians of the importance of B-blocker use after an acute myocardial infarction (AMI) and both the Health Care Financing Administration and the National Committee for Quality Assurance have adopted B-blocker use after AMI as a quality-of-care indicator.
"Despite the evidence and the published guidelines, studies have repeatedly demonstrated wide variation and under-use of B-blockers," the Yale researchers said in a study published in the May 23 issue of the Journal of the American Medical Association.
To find out why B-blockers were underused, researchers at Yale conducted in-depth interviews with 45 key physician, nursing, quality management and administrative participants at eight U.S. hospitals. The study was funded by the Agency for Healthcare Research and Quality.
"While the industry has made substantial advances in measuring and improving the quality of its products, these lessons are not easily translated into the complex health care environment," says Dr. Harlan Krumholz, senior author of the study and associate professor of internal medicine and cardiology at the School of Medicine. "Efforts to improve the quality of care in the health care system are increasingly common, but factors associated with successful initiatives are not well understood."
The researchers found six characteristics at hospitals where B-blockers were used frequently: goals for improvement; administrative support for improvement efforts; support among clinicians for such efforts; design and implementation of initiatives for performance improvement; use of data concerning B-blocker use; and a set of modifying variables.
According to Elizabeth Bradley, first author and assistant professor in the Department of Epidemiology and Public Health, "The hospitals with the best performance were characterized by having clear support from their administration, strong physician leadership, a sense of shared goals and a way of monitoring their progress. These features were not generally present in the hospitals that did not perform as well."
Coauthors of the study included Dr. Eric Holmboe, Jennifer Mattera, Sarah Roumanis and Dr. Martha Radford.
-- By Jacqueline Weaver
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MEDICAL SCHOOL NEWSYale researchers weigh-in on risk of getting Lyme disease
Mentally ill may receive inferior cardiac care
Snoring, other sleep disorders increase stroke risk
Tobacco products do not appear to cause brain cancer
People in certain occupations at greater risk of developing brain cancer
Recommended beta blockers not prescribed enough . . .
Faculty honored for their research on interaction of brain cells . . .
Neurobiologist describes evolution of neocortex in prestigious lectureship
New guidelines developed for tracking severity of gastrointestinal disease
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