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Abstract：
Guidelines recommend statin therapy for all patients with peripheral artery disease (PAD) due to the increased risk of adverse cardiovascular events. A lack of adherence to these guidelines was identified at a vascular clinic located in the southeastern United States. The aim of this nurse practitioner-led quality improvement project was to increase the percentage of patients with lower extremity PAD who were prescribed a statin medication at this clinic. Baseline data were obtained via a chart review. Using the Plan-Do-Study-Act (PDSA) model, a paper tool depicting an evidence-based algorithm was implemented in the clinic for 6 weeks to increase awareness of guidelines (PDSA cycle 1). Next, an electronic pop-up reminder was implemented in the electronic health record for the following 6 weeks (PDSA cycle 2). Data were collected throughout the process and analyzed to determine if either intervention increased the number of patients with PAD who were prescribed a statin medication. Baseline data revealed only 54.16% of patients were on a statin medication. After PDSA cycle 1, an average of 70.8% of patients were on a statin medication. PDSA cycle 2 revealed an average of 73.3% of patients were taking a statin medication. ANOVA was conducted and showed statistical significance between the groups (P = .003). There was statistical significance between baseline and implementation of the algorithm and baseline and implementation of the pop-up, but not between the 2 interventions. These findings are consistent with research suggesting algorithms and electronic reminders may increase medical staff awareness of guidelines. Standardization of these interventions enhanced provider adherence to guidelines and ultimately improved patient outcomes.
摘要：
由于不良心血管事件的风险增加，指南建议对所有外周动脉疾病（PAD）患者进行他汀类药物治疗。在美国东南部的一家血管诊所发现缺乏对这些指南的遵守。这个以执业护士为主导的质量改进项目的目的是增加在该诊所开具他汀类药物的下肢PAD患者的百分比。基线数据是通过图表审查获得的。使用计划-做-研究-行动(PDSA)模型，我们在临床中实施了一个描述循证算法的纸质工具,持续6周,以提高对指南的认识(PDSA第1周期).接下来,在接下来的6周(PDSA第2周期),在电子健康记录中实施了电子弹出提醒.在整个过程中收集数据并进行分析，以确定任一干预措施是否增加了服用他汀类药物的PAD患者的数量。基线数据显示，只有54.16%的患者服用他汀类药物。PDSA第1周期后，平均70.8%的患者服用他汀类药物。PDSA第2周期显示平均73.3%的患者服用他汀类药物。进行方差分析并显示组间的统计学意义(P=.003)。算法的基线和实现以及弹出窗口的基线和实现之间存在统计意义，但不是在两次干预之间。这些发现与研究表明算法和电子提醒可以提高医务人员对指南的认识是一致的。这些干预措施的标准化增强了提供者对指南的依从性，并最终改善了患者的预后。
