Journal»Dissertation Abstracts International: Section B: The Sciences and Engineering
Year»2018
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Background. Although earlier reviews establish that patients with coronary heart disease (CHD) respond well to cardiac rehabilitation (CR), the comparative effectiveness of different CR programs or their individual core components of CR have not been evaluated. Methods. A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of CR (nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. The core components were evaluated individually and as part of broader CR treatment categories ("exercise-only" CR programs, "comprehensive" CR programs, and "secondary prevention programs without exercise"). Published RCTs were identified from database inception dates (Medline, Medline In-Process, the Cochrane database, Embase, CINAHL, Sci-Expanded, PsychINFO, the Web of Science) to July 2014. Endpoints included measures of mortality (all-cause and CV) and morbidity (myocardial infarction (MI), revascularization, and hospitalization). Hazard ratios (HR) and 95% credible intervals (CrIs) were used as summary measures. Findings. 136 trials (50,054 participants) and 169 trials (62,149 participants) were included for the NMAs of the overall CR treatment strategies and for the core components of CR respectively. "Exercise-only" and "comprehensive" CR programs significantly reduced the hazards of all-cause mortality, CV mortality, total MI, fatal MI, non-fatal MI, revascularization, total and CV hospitalization by 25-54% when compared to usual care, and significantly reduced the hazard of all-cause mortality by 23%-26% when compared to "secondary prevention programs without exercise". "Secondary prevention programs without exercise" significantly reduced the hazards of all-cause and CV mortality, total MI, non-fatal MI, all-cause and CV hospitalization by 20%-43% when compared to usual care. The core component of PM significantly reduced the hazards of all-cause mortality, all-cause and CV hospitalization by 31%, 33% and 50% respectively. RFM and PE significantly reduced the hazards of total MI and all-cause hospitalization by 37% and 23% respectively. Interpretation. These findings confirm the central role of CR in patients with CHD, emphasize the central role of exercise training in CR, elevate the role of other key CR core components, especially psychosocial management, and establish the superiority of exercise-based CR programs to "secondary prevention programs without exercise". (PsycINFO Database Record (c) 2017 APA, all rights reserved)
PURPOSE: To review the literature concerning strategies for implementing quality indicators in hospital care, and their effectiveness in improving the quality of care.
DATA SOURCES: A systematic literature study was carried out using MEDLINE and the Cochrane Library (January 1994 to January 2008).
STUDY SELECTION: Hospital-based trials studying the effects of using quality indicators as a tool to improve quality of care.
DATA EXTRACTION: Two reviewers independently assessed studies for inclusion, and extracted information from the studies included regarding the health care setting, type of implementation strategy and their effectiveness as a tool to improve quality of hospital care.
RESULTS: A total of 21 studies were included. The most frequently used implementation strategies were audit and feedback. The majority of these studies focused on care processes rather than patient outcomes. Six studies evaluated the effects of the implementation of quality indicators on patient outcomes. In four studies, quality indicator implementation was found to be ineffective, in one partially effective and in one it was found to be effective. Twenty studies focused on care processes, and most reported significant improvement with respect to part of the measured process indicators. The implementation of quality indicators in hospitals is most effective if feedback reports are given in combination with an educational implementation strategy and/or the development of a quality improvement plan.
CONCLUSION: Effective strategies to implement quality indicators in daily practice in order to improve hospital care do exist, but there is considerable variation in the methods used and the level of change achieved. Feedback reports combined with another implementation strategy seem to be most effective.
Background: Many people advocate audit and feedback as a strategy for improving professional practice. The main results of an update of a Cochrane review on the effects of audit and feedback are reported. Data sources: The Cochrane Effective Practice and Organisation of Care Group's register up to January 2004 was searched. Randomised trials of audit and feedback that reported objectively measured professional practice in a healthcare setting or healthcare outcomes were included. Review methods: Data were independently extracted and the quality of studies were assessed by two reviewers. Quantitative, visual and qualitative analyses were undertaken. Main results: 118 trials are included in the review. In the primary analysis, 88 comparisons from 72 studies were included that compared any intervention in which audit and feedback was a component to no intervention. For dichotomous outcomes, the median-adjusted risk difference of compliance with desired practice was 5% (interquartile range 3-11). For continuous outcomes, the median-adjusted percentage change relative to control was 16% (interquartile range 5-37). Low baseline compliance with recommended practice and higher intensity of audit and feedback appeared to predict the effectiveness of audit and feedback. Conclusions: Audit and feedback can be effective in improving professional practice. The effects are generally small to moderate. The absolute effects of audit and feedback are likely to be larger when baseline adherence to recommended practice is low and intensity of audit and feedback is high.
Background. Although earlier reviews establish that patients with coronary heart disease (CHD) respond well to cardiac rehabilitation (CR), the comparative effectiveness of different CR programs or their individual core components of CR have not been evaluated. Methods. A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of CR (nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. The core components were evaluated individually and as part of broader CR treatment categories ("exercise-only" CR programs, "comprehensive" CR programs, and "secondary prevention programs without exercise"). Published RCTs were identified from database inception dates (Medline, Medline In-Process, the Cochrane database, Embase, CINAHL, Sci-Expanded, PsychINFO, the Web of Science) to July 2014. Endpoints included measures of mortality (all-cause and CV) and morbidity (myocardial infarction (MI), revascularization, and hospitalization). Hazard ratios (HR) and 95% credible intervals (CrIs) were used as summary measures. Findings. 136 trials (50,054 participants) and 169 trials (62,149 participants) were included for the NMAs of the overall CR treatment strategies and for the core components of CR respectively. "Exercise-only" and "comprehensive" CR programs significantly reduced the hazards of all-cause mortality, CV mortality, total MI, fatal MI, non-fatal MI, revascularization, total and CV hospitalization by 25-54% when compared to usual care, and significantly reduced the hazard of all-cause mortality by 23%-26% when compared to "secondary prevention programs without exercise". "Secondary prevention programs without exercise" significantly reduced the hazards of all-cause and CV mortality, total MI, non-fatal MI, all-cause and CV hospitalization by 20%-43% when compared to usual care. The core component of PM significantly reduced the hazards of all-cause mortality, all-cause and CV hospitalization by 31%, 33% and 50% respectively. RFM and PE significantly reduced the hazards of total MI and all-cause hospitalization by 37% and 23% respectively. Interpretation. These findings confirm the central role of CR in patients with CHD, emphasize the central role of exercise training in CR, elevate the role of other key CR core components, especially psychosocial management, and establish the superiority of exercise-based CR programs to "secondary prevention programs without exercise". (PsycINFO Database Record (c) 2017 APA, all rights reserved)
