Acute Myocardial Infarction Setting Priorities for Effectiveness Research (1990) / Chapter Skim
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Appendix A: Background and Conduct of the Workshop
Appendix A: Background and Conduct of the Workshop
Pages 49-62
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From page 49... ...
The main elements of the project were background reading, information on data sets of the Health Care Financing Administration (HCFA) and analyses done for the workshop, and a committee homework exercise that yielded a first-round set of patient management topics.
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The Gird and fourth files are He Utilization Records for Medicare Parts A and B billing information, including hospital days of care, diagnoses, surgical procedures, physician visits, charges, and payments. The fifth main record group is the Provider Cost Report Record, which has cost, accounting, and other data from participating institutional providers.
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from selected inpatient medical records. One mechanism may be through the Medicare PROs by means of He proposed Uniform Clinical Data Set.
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The availability of extensive clinical information collected in UCDS formats would support much more thorough and detailed analysis of patterns of interventions and of outcomes than is possible simply with billing data. Thus, for patients with particular medical conditions, such as acute myocardial infarction, a large body of information could be made available to He medical community and for intramural and extramural research.
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HCFA is also working to develop mechanisms to collect measures of functional impairment and other patient outcome data more directly. Acute Myocardial Infarction Analyses Illustrating the Use of Medicare Data HCFA staff compiled an array of data tables from their analyses of Medicare files on myocardial infarction, exercise testing, revascularization, and other cardiovascular conditions and interventions illustrative of the types of analyses that might be done with AMI data.
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systolic; diastolic SOURCE: "Resource Manual for Uniform Clinical Data Set (UCDS) " prepared by Case Mix Research, Queens University, Department of Community Health and Epidemiology, Kingston, Ontario, Canada in association with Wisconsin Peer Review Organization (WIPRO)
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In 25 to 30 percent of hospitalizations with the principal diagnosis of AMI, there are no substantiating clinical objective findings (e.g., electrocardiographic changes or enzyme elevations) in a clinical database abstracted by the PROs for different HCFA projects.
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HOMEWORK EXERCISE The homework exercise was conducted as the first part of a modified Delphi process, in which committee members completed questionnaires to nominate Tree major patient management topics and then to elaborate the research activities they would recommend for those specific topics. Table A.2 lists the topics nominated in the fust round.
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Other outcome research topics I Rehabilitation TABLE A.3 Summary of Research Activities Recommended for Primary Prevention, Patien9Public Education, Physician Education, and General Management in Acute Myocardial Infarction PRIMARY PREVENTION AND PATENT/PUBLIC EDUCATION STRATEGIES I
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Formal cardiac rehabilitation programs 1. Determine effectiveness of fonnal cardiac rehabilitation programs in terms of functional status, q ,rlity of life, return to work, etc., for asymptomatic and complicated postAMI patients TABLE A.5 Summary of Research Activities Recommended for Use of Therapies and Procedures in Acute Myocardial l~farction USE OF THROMBOLY1IC TIERAPES I
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Study whether and how new thrombolytic agents influence patient management decisions and outcomes USE OF CATHETERIZATION I Related to admission 1.
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Test whether use of automatic nonimplantable defibrillator and heart rate and blood pressure automatic system reduces CCU costs by allowing movement of CCU patients to regular beds 2. Determine what types of patients require, or do not require, CCU care when the main purpose of the CCU is to detect life-threatening arrhythmias TABLE A.6 Summary of Research Activities Recommended for Risk Stratification of Patients After Acute Myocardial Infarction I
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Determine the health status outcomes of AMI including disability, functional recovery, and quality of life for elderly AMI patients in general and for dose treated by different modalities, under different payment systems, in different facilities, and with different sociodemographic characteristics II. Outcomes and influence of age 1.
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