Benefits of an "angina clinic" for patients with coronary artery disease: a demonstration of health status measures as markers of health care quality.
OBJECTIVE
Our purpose was to determine the efficacy of health status measurement in quantifying improvements in quality of care provided by an "angina clinic."


METHODS
In a pretest-posttest, nonequivalent control group design in the outpatient clinics of a Veterans Affairs Medical Center, 535 patients with coronary disease were followed up, without intervention, for 3 months and were defined as the "usual-care" group. Concurrently, a clinical trial that optimized the antianginal medications of 100 patients with chronic, stable coronary disease was conducted and defined as the "angina clinic" group. The 3-month change in scores for the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific health status measure for patients with coronary disease, was used as the main outcome measure.


RESULTS
After baseline differences between groups were controlled, the "angina clinic" conferred substantial improvement on patient symptom control (3-month benefit in angina frequency +9.4, P <.001; in angina stability +14.7, P <.001), treatment satisfaction (+8.6, P <.001), quality of life (+6.8, P <.001), and physical limitations resulting from coronary disease (+3.6, P =.047). Only the changes in physical limitation were not clinically significant.


CONCLUSIONS
Disease-specific health status measures can provide valuable insights into the quality of care associated with innovations in health care delivery. These results suggest that patients in a clinical trial optimizing antianginal medications had greater improvements in symptom control, treatment satisfaction, and quality of life compared with similar patients receiving "usual care" in a general medicine clinic.
Spertus
John A
JA
Department of Medicine, Section of Cardiology, Mid America Heart Institute, University of Missouri, Kansas City, Mo 64111, USA. spertusj@umkc.edu
Dewhurst
Tim A
TA
Dougherty
Cynthia M
CM
Nichol
Paul
P
McDonell
Mary
M
Bliven
Brent
B
Fihn
Stephan D
SD
D000368:Aged; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D018802:Patient-Centered Care; D010865:Pilot Projects; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires