We plan to establish a comprehensive national center for the integration of information about medical technologies and other processes of care in patients during and after an acute myocardial infarction. By picking patients having an acute MI as the starting point, we will be basing our work on a low variation (nondiscretionary) admission; by following these patients over time we will be able to study many aspects of chronic care using a reliable """"""""inception cohort"""""""". Our analyses will be based on several sources of data: MEDPAR data, comparable information from the PTF file in the VA and from two Canadian provinces, original survey data, information from existing data banks, and the published literature. We will establish several mechanisms for disseminating our results (at the level of an entire state, in Regions of the VA system, and in sections of states) and will compare the effectiveness of these mechanisms in minimizing inappropriate variations in process of care. We will utilize a national Advisory Board with representatives from the three large trials of thrombolysis (TAMI, TIMI and Western Washington), a local Advisory Board and several groups of physicians who routinely care for AMI patients. These groups will help us identify key controversies and will in the formulation of the analyses and the interpretation of the data.
| McClellan, M; McNeil, B J; Newhouse, J P (1994) Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables. JAMA 272:859-66 |
