RESUMEN
Adherence to evidence-based interventions for hospitalized cardiovascular disease patients is not optimal. This study assesses the impact of a national quality improvement program on adherence to guidelines in these patients. Data from 92 hospitals from across the United States participating in the Get With The Guidelines program for at least 1 year for 11 acute and secondary prevention measures from a preintervention baseline period and the subsequent 4 quarters of a quality improvement intervention were analyzed. A patient group of 45,988 patients with acute myocardial infarction, unstable angina, revascularization, or peripheral vascular disease was included in this evaluation. Significant improvement from baseline was seen in 10 of 11 measures by the fourth quarter: use of early aspirin for acute myocardial infarction, 76.4% to 88.0% (P < 0.0001); early beta-blocker for acute myocardial infarction, 64.4% to 79.5% (P < 0.0001); beta-blocker at discharge, 75% to 82.1% (P < 0.0001); smoking cessation counseling, 58.7% to 74.3% (P < 0.0001); angiotensin-converting enzyme inhibitor use for acute myocardial infarction, 64.5% to 69.9% (P < 0.0001); lipid treatment, 58.5% to 63.4% (P < 0.0001); lipid treatment for low-density lipoprotein > or =100 mg/dL, 60.4% to 67.0% (P < 0.0001); low-density-lipoprotein measurement, 48.8% to 53.2% (P < 0.0001); discharge blood pressure <140/90 mm Hg, 65.9% to 68.0% (P = 0.03); and referral to cardiac rehabilitation or exercise counseling, 65.0% to 88.3% (P < 0.001). Discharge aspirin use at 89.9% did not change. Statistically and clinically significant improvement in 10 of 11 quality-improvement measures for the treatment of patients hospitalized for cardiovascular disease was seen in hospitals participating in Get With The Guidelines.
Asunto(s)
Enfermedad Coronaria/cirugía , Adhesión a Directriz/tendencias , Pacientes Internos , Revascularización Miocárdica , Guías de Práctica Clínica como Asunto/normas , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud , Anciano , Femenino , Hospitales/normas , Humanos , Masculino , Resultado del Tratamiento , Estados UnidosAsunto(s)
Servicio de Cardiología en Hospital/normas , Enfermedades Cardiovasculares/prevención & control , Continuidad de la Atención al Paciente/normas , Sistemas de Apoyo a Decisiones Clínicas , Consultorios Médicos , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Gestión de la Calidad Total , Estados UnidosRESUMEN
OBJECTIVE: To describe the impact of a commercial insurer's financial incentives to hospitals in conjunction with collaboration with the American Heart Association (AHA) to accelerate implementation of Get With The Guidelines-Coronary Artery Disease (GWTG-CAD), a quality improvement program to rapidly improve cardiovascular secondary prevention in hospitalized patients. STUDY DESIGN: Observational assessment of quality improvement program participation and implementation in response to financial incentives. METHODS: The study population included all hospitals that participated with the Hawaii Medical Service Association (HMSA, Blue Cross Blue Shield of Hawaii) Hospital Quality and Service Recognition Program and had more than 30 annual admissions for acute coronary artery disease. These 13 hospitals were given encouragement and financial incentives to implement GWTG-CAD. Financial incentives were determined by a prorated amount of the total HMSA hospital reimbursement for all acute services, as part of a more comprehensive hospital "pay for performance" program. RESULTS: Incentives to 10 of 13 eligible hospitals included reimbursement for half the annual cost of the AHA Patient Management Tool. In addition, HMSA's pay for performance program--the Hospital Quality and Service Recognition Program--distributed monetary awards totaling 354,883 dollars, based on points awarded for GWTG-CAD workshop attendance documentation (10 hospitals), recognition by the AHA as a GWTG-CAD hospital, and attainment of 85% adherence to the GWTG-CAD performance measures (4 hospitals). CONCLUSIONS: Community-based promotion of GWTG-CAD and financial incentives provided by a commercial insurer resulted in the rapid implementation of a secondary prevention program for coronary artery disease in most hospitals in the State of Hawaii within a single year.
Asunto(s)
Enfermedades Cardiovasculares/terapia , Economía Hospitalaria , Adhesión a Directriz , Motivación , Garantía de la Calidad de Atención de Salud/métodos , Hawaii , Investigación sobre Servicios de Salud , Hospitalización , HumanosRESUMEN
This article presents a collaborative model for hospital-based cardiovascular secondary prevention. The model employs a stake holder consortium to provide hospitals with a unified approach to improve care and conform to regulatory requirements. Hospital teams use a Web-based tool that embeds data collection in the process of care and supports rapid cycle improvement. Recognition of participation and achievement by the American Heart Association helps to obtain administrative support for the program.