「內外兼修、相輔相成」：運用臨床決策系統提升心臟內外科，對複雜性冠狀動脈疾病病人的照護品質

Implementation of clinical decision support system to promote heart team discussion for the healthcare quality of complex coronary artery disease

"前言：複雜性冠狀動脈疾病最常見的侵入性治療是冠狀動脈血管介入術及繞道手術，心臟團隊運作在決定病人適合哪一種侵入性治療方式扮演重要的角色，尤其針對冠狀動脈血管病變複雜度較高的病人，心臟團隊運作可以提供最適化之臨床建議。 材料與方法：本團隊提升跨科合作、建置治療決策流程、運用臨床決策系統的概念建置危險評估SYNTAX Score 之資訊系統、有效heart team discussion 啟動來提升複雜性冠狀動脈疾病病人的照護品質。 結果：歷經六個月的改善過程，SYNTAX Score 評分比率從4% 顯著提升到96.5%（P<0.001）；啟動heart team discussion 達成率從26.4% 顯著提升到73.8% ( P <0.001）；複雜性冠狀動脈疾病病人接受冠狀動脈繞道手術的比率則從10.5% 提升到17.8%（P =0.097）；經過平均462 天追蹤，有啟動Heart team 的病人，傾向有較低的複合性評估指標事件率（包含死亡、再發生心肌梗塞及非計畫性冠狀動脈血管重建）。 結論：發展疾病治療決策流程，運用臨床決策系統概念建置SYNTAX Score 資訊系統，能有效提升心臟內外科之對話，提供最適化之臨床建議，以提升病人照護品質。"

"Background: The most common invasive procedures for complex coronary artery disease (CAD) are percutaneous coronary intervention and coronary artery bypass grafting (CABG). Heart team discussion plays an important role in determining which invasive treatment is suitable for the patient, especially for those with highly complex coronary lesions. Materials and methods: Our quality improvement team aimed to improve the healthcare quality for patients with complex CAD by promoting interdisciplinary collaboration, establishing a treatment decision-making flow chart, completing risk assessment (SYNTAX Score) assisted by a clinical decision supporting system, and activating heart team discussion if indicated. Results: After six-month quality improvement process, the assessment rate of the SYNTAX Score was from 4% to 96.5% (P <0.001), and the activation of heart team discussion was significantly increased from 26.4% to 73.8% (P <0.001). The CABG rate for patients with complex CAD tended to be higher after quality improvement (17.8% vs. 10.5% , P = 0.097) despite no statistical significance. Heart team intervention was associated with a numerically lower risk of death, myocardial infarction or unplanned coronary revascularization. Conclusions: It can effectively enhance the dialogue between cardiologists and cardiovascular surgeons and provide the most suitable clinical advice to improve the healthcare quality of complex CAD by establishing a treatment decision-making flow chart, and completing risk assessment assisted by a clinical decision supporting system."