PDF(Pubmed)
Abstract：
UNASSIGNED: Quantifying guideline-directed medical therapy (GDMT) intensity is foundational for improving heart failure (HF) care. Existing measures discount dose intensity or use inconsistent weighting.
UNASSIGNED: The Kansas City Medical Optimization (KCMO) score is the average of total daily to target dose percentages for eligible GDMT, reflecting the percentage of optimal GDMT prescribed (range, 0-100). In Change the Management of Patients With HF, we computed KCMO, HF collaboratory (0-7), and modified HF Collaboratory (0-100) scores for each patient at baseline and for 1-year change in established GDMT at the time (mineralocorticoid receptor antagonist, β-blocker, ACE [angiotensin-converting enzyme] inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor). We compared baseline and 1-year change distributions and the coefficient of variation (SD/mean) across scores.
UNASSIGNED: Among 4532 patients at baseline, mean KCMO, HF collaboratory, and modified HF Collaboratory scores were 38.8 (SD, 25.7), 3.4 (1.7), and 42.2 (22.2), respectively. The mean 1-year change (n=4061) for KCMO was -1.94 (17.8); HF collaborator, -0.11 (1.32); and modified HF Collaboratory, -1.35 (19.8). KCMO had the highest coefficient of variation (0.66), indicating greater variability around the mean than the HF collaboratory (0.49) and modified HF Collaboratory (0.53) scores, reflecting higher resolution of the variability in GDMT intensity across patients.
UNASSIGNED: KCMO measures GDMT intensity by incorporating dosing and treatment eligibility, provides more granularity than existing methods, is easily interpretable (percentage of ideal GDMT), and can be adapted as performance measures evolve. Further study of its association with outcomes and its usefulness for quality assessment and improvement is needed.
UNASSIGNED: The Kansas City Medical Optimization (KCMO) score is the average of total daily to target dose percentages for eligible GDMT, reflecting the percentage of optimal GDMT prescribed (range, 0-100). In Change the Management of Patients With HF, we computed KCMO, HF collaboratory (0-7), and modified HF Collaboratory (0-100) scores for each patient at baseline and for 1-year change in established GDMT at the time (mineralocorticoid receptor antagonist, β-blocker, ACE [angiotensin-converting enzyme] inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor). We compared baseline and 1-year change distributions and the coefficient of variation (SD/mean) across scores.
UNASSIGNED: Among 4532 patients at baseline, mean KCMO, HF collaboratory, and modified HF Collaboratory scores were 38.8 (SD, 25.7), 3.4 (1.7), and 42.2 (22.2), respectively. The mean 1-year change (n=4061) for KCMO was -1.94 (17.8); HF collaborator, -0.11 (1.32); and modified HF Collaboratory, -1.35 (19.8). KCMO had the highest coefficient of variation (0.66), indicating greater variability around the mean than the HF collaboratory (0.49) and modified HF Collaboratory (0.53) scores, reflecting higher resolution of the variability in GDMT intensity across patients.
UNASSIGNED: KCMO measures GDMT intensity by incorporating dosing and treatment eligibility, provides more granularity than existing methods, is easily interpretable (percentage of ideal GDMT), and can be adapted as performance measures evolve. Further study of its association with outcomes and its usefulness for quality assessment and improvement is needed.
摘要：
■量化指南指导的药物治疗（GDMT）强度是改善心力衰竭（HF）护理的基础。现有措施降低剂量强度或使用不一致的权重。
■堪萨斯城医学优化（KCMO）评分是合格GDMT的每日总剂量与目标剂量百分比的平均值，反映规定的最佳GDMT的百分比(范围，0-100）。在改变HF患者的管理中，我们计算了KCMO，HF合作（0-7），和改良的HFCollaboratory(0-100)评分为每个患者的基线和1年时已建立的GDMT的变化(盐皮质激素受体拮抗剂,β-受体阻滞剂,ACE[血管紧张素转换酶]抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂）。我们比较了基线和1年的变化分布以及分数之间的变异系数（SD/平均值）。
■在基线时的4532名患者中，意思是KCMO，HF合作，改良的HF校准评分为38.8分（SD，25.7),3.4(1.7)、和42.2(22.2)，分别。KCMO的平均1年变化(n=4061)为-1.94(17.8)；HF合作者，-0.11(1.32);和改进的HF协作,-1.35（19.8）。KCMO的变异系数最高(0.66)，表明平均值比HF协作（0.49）和改良的HF协作（0.53）分数更大的变异性，反映了患者GDMT强度变异性的更高分辨率。
■KCMO通过纳入剂量和治疗资格来测量GDMT强度，提供比现有方法更多的粒度，很容易解释(理想GDMT的百分比)，并且可以随着绩效指标的发展而调整。需要进一步研究其与结果的关联及其对质量评估和改进的有用性。
■堪萨斯城医学优化（KCMO）评分是合格GDMT的每日总剂量与目标剂量百分比的平均值，反映规定的最佳GDMT的百分比(范围，0-100）。在改变HF患者的管理中，我们计算了KCMO，HF合作（0-7），和改良的HFCollaboratory(0-100)评分为每个患者的基线和1年时已建立的GDMT的变化(盐皮质激素受体拮抗剂,β-受体阻滞剂,ACE[血管紧张素转换酶]抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂）。我们比较了基线和1年的变化分布以及分数之间的变异系数（SD/平均值）。
■在基线时的4532名患者中，意思是KCMO，HF合作，改良的HF校准评分为38.8分（SD，25.7),3.4(1.7)、和42.2(22.2)，分别。KCMO的平均1年变化(n=4061)为-1.94(17.8)；HF合作者，-0.11(1.32);和改进的HF协作,-1.35（19.8）。KCMO的变异系数最高(0.66)，表明平均值比HF协作（0.49）和改良的HF协作（0.53）分数更大的变异性，反映了患者GDMT强度变异性的更高分辨率。
■KCMO通过纳入剂量和治疗资格来测量GDMT强度，提供比现有方法更多的粒度，很容易解释(理想GDMT的百分比)，并且可以随着绩效指标的发展而调整。需要进一步研究其与结果的关联及其对质量评估和改进的有用性。
