RESUMEN

BACKGROUND: Percutaneous coronary intervention (PCI) is the most commonly used procedure for coronary revascularization. There are multiple adjuvant anticoagulation strategies available. In this era of cost containment, we performed a comparative effectiveness analysis of clinical outcomes and cost of the major anticoagulant strategies across all types of PCI procedures in a large observational database. METHODS: A retrospective, comparative effectiveness analysis of the Premier observational database was conducted to determine the impact of anticoagulant treatment on outcomes. Multiple linear regression and logistic regression models were used to assess the association of initial antithrombotic treatment with outcomes while controlling for other factors. RESULTS: A total of 458,448 inpatient PCI procedures with known antithrombotic regimen from 299 hospitals between January 1, 2004 and March 31, 2008 were identified. Compared to patients treated with heparin plus glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin was associated with a 41% relative risk reduction (RRR) for inpatient mortality, a 44% RRR for clinically apparent bleeding, and a 37% RRR for any transfusion. Furthermore, treatment with bivalirudin alone resulted in a cost savings of $976 per case. Similar results were seen between bivalirudin and heparin in all end-points. Combined use of both bivalirudin and GPI substantially attenuated the cost benefits demonstrated with bivalirudin alone. CONCLUSION: Bivalirudin use was associated with both improved clinical outcomes and decreased hospital costs in this large "real-world" database. To our knowledge, this study is the first to demonstrate the ideal comparative effectiveness end-point of both improved clinical outcomes with decreased costs in PCI.

Asunto(s)

Anticoagulantes/uso terapéutico , Hemorragia/inducido químicamente , Fragmentos de Péptidos/uso terapéutico , Intervención Coronaria Percutánea/economía , Inhibidores de Agregación Plaquetaria/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/economía , Antitrombinas/economía , Antitrombinas/uso terapéutico , Análisis Costo-Beneficio , Femenino , Heparina/economía , Heparina/uso terapéutico , Hirudinas/economía , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Observación , Fragmentos de Péptidos/economía , Inhibidores de Agregación Plaquetaria/economía , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria , Proteínas Recombinantes/economía , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Adulto Joven

RESUMEN

Suggestions for gaining active participation of clinicians in the design and implementation of a clinical IT system include: Selecting open and easy-to-use systems, Gaining organization-wide buy in, Successfully articulating the benefits of these technologies for both patients and the organization.

Asunto(s)

Difusión de Innovaciones , Sistemas de Información en Hospital , Cultura Organizacional , Administración de Personal en Hospitales/métodos , Estados Unidos

RESUMEN

The tracking of public opinion can be a critical component of antitobacco campaigns, such as efforts to enact citywide Clean Indoor Air legislation. Grassroots tobacco control coalitions that work locally to promote smoke-free environments typically encompass individuals from a wide range of public health fields. Although knowledgeable, volunteer groups lack the financial resources to evaluate the impact of local efforts or determine their community's level of support for potential legislation. The steps taken by a grassroots organization to conduct a public opinion survey are outlined, including methodological, analytical issues, and resource requirements. A valid survey can be completed in 4 months with minimal financial resources. Individuals willing to voluntarily administer and analyze a survey can be identified at the local level. Results of a tobacco-related public opinion survey can be instrumental in the promotion of smoke-free environments and an effective tool in attracting media coverage.

Asunto(s)

Contaminación del Aire Interior/legislación & jurisprudencia , Actitud Frente a la Salud , Recolección de Datos/métodos , Opinión Pública , Política Pública , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación del Aire Interior/prevención & control , Recolección de Datos/instrumentación , Interpretación Estadística de Datos , Toma de Decisiones en la Organización , Federación para Atención de Salud , Humanos , Ohio , Prevención del Hábito de Fumar , Contaminación por Humo de Tabaco/prevención & control , Estados Unidos , Voluntarios

RESUMEN

Preview When a patient presents with involuntary weight loss, the etiologic considerations can be overwhelming. To plan a cost- effective workup, physicians need to be aware of the most common causes of weight loss and the tests that yield the most pertinent data. Drs Wise and Craig review the clinical studies on unintentional weight loss and suggest an initial approach to management.