Implementing AHA Quality Improvement Programs: Get With the Guidelines
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2 Implementing AHA Quality Improvement Programs: Get With the Guidelines Sidney C. Smith, Jr. MD FAHA, FACC, FESC Professor of Medicine/Cardiology University of North Carolina Past President, American Heart Association No Relationships with Industry or Conflicts of Interest for this Presentation
3 Institute of Medicine Report: Quality Chasm In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves. Design Rule 5: Current: Decision making is based on training and experience. New: Decision making is based on evidence. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically form clinician to clinician or from place to place. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century Washington: National Academy Press, 2001
4 THURSDAY, NOVEMBER 26, 2002
5 Cumulative Impact of Simple Cardiovascular Protective Medications Relative-risk 5yr CV event rate None % Aspirin 25% 15% Beta blocker 25% 11.3% ACE inhibitor 25% 8.4% Statin Rx 30% 5.9% Cumulative risk reduction if all four therapies are used: 77% Absolute risk reduction: 15.4%, NNT = 6 Intensive Statin 22% 4.6% CV event = CV death, MI, or stroke Fonarow Am J Cardiol 2001;85:10A-17A and Yusuf Lancet 2002;360:2-3
6 Heart and Stroke Patient Treatment More than half of all heart disease and stroke patients do not receive consistent preventive therapy upon discharge from the hospital While evidence-based guidelines for AMI, HF, and Stroke care have been developed along with improved diagnostic and treatment modalities, there are gaps, variations, and disparities in how these are applied. Furthermore many hospitals may not have the systems, organization, staff to provide highly reliable care at all times *The Wall Street Journal, November 9, 2003, Physicians Weekly, June 21, 2004, ADHERE Study 6
7 Variability in Care Quality
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9 Bridging the Gap Between Knowledge and Clinical Practice AHA/ACC Guidelines I IIa IIb III Systems Clinical Practice Clinical trial evidence National guidelines Implement evidence-based care Improve communications Ensure compliance Improve quality of care Improve outcomes Adapted from the American Heart Association. Get With The Guidelines; 2001.
10 Since 2000: Get With The Guidelines Over 2100 US Hospitals Nationwide Over 6.5 Million Patient Records Over 1100 Hospitals Receiving Recognition 300+ Peer Reviewed Publications As of September 2015
11 AHA/ASA GWTG Program GWTG is a national initiative of the AHA to improve care quality and guidelines adherence in patients hospitalized with cardiovascular disease. GWTG uses collaborative learning sessions, conference calls, e- mail and staff support to assist hospital teams improve acute and secondary prevention care systems. A web-based Patient Management Tool is used for point of care data collection and decision support, on-demand reporting, communication and patient education.
12 Building the GWTG Hospital Team Physician Champion(s) Nurses Pharmacists Hospital Administrators Directors of Cardiac Services, Quality Improvement and Case Management Cardiac Rehab Team
13 Reach of GWTG in the US
14 Compliance GWTG-CAD Performance Measures 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% ASA within 24 Hours ASA at Discharge Beta Blockers at Discharge ACEI or ARB at D/C for LVSD Lipid Lowering Therapy at D/C for LDL > 100 Baseline 82.1% 83.3% 77.9% 68.8% 72.1% 62.6% 76.9% 56.1% Current 91.3% 94.4% 93.8% 91.5% 92.1% 98.2% 93.0% 85.9% Performance Measure Smoking Cessation Counseling Composite Performance Measure 100% Compliance Measure Baseline = Admissions Jan2002 Dec2002 January 2009 Current = Admissions Jan2008-Dec2008
15 Compliance GWTG-Stroke Performance Measures 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% tpa < 3hr with Arrival < 2hr after Onset Early Antithrombotic VTE Prophylaxis Antithrombotic Tx at Discharge Anticoag. Tx at Discharge for Afib Lipid Lowering Therapy at D/C for LDL > 100 Smoking Cessation Counseling Composite Performance Measure 100% Compliance Measure Baseline 31.2% 90.9% 72.2% 93.7% 65.9% 40.1% 46.5% 72.1% 42.1% Current 86.5% 97.3% 98.5% 98.0% 94.2% 96.3% 96.5% 96.8% 92.8% Achievement Measure Baseline = Admissions Apr2003 Mar2004 Current = Overall April 2014
16 Get With The Guidelines Works! Hospitals Participating in GWTG Provide Higher Quality Care with Better Clinical Outcomes than Other Hospitals
17 In-hospital Mortality and Guideline Adherence
18 Population Level Impact: Declines in AMI, HF and Ischemic Stroke Mortality
19 AHA GWTG is Award Winning First hospital-based program to receive the prestigious Innovation in Prevention Award from U.S. Department of Health and Human Services. Recipient of Inaugural ehealth Initiative (ehi) Award Honoring Leadership in Health Care Quality through Health IT for Transforming Care Delivery
20 2014 Recognition Opportunities HF and Stroke Plus, Gold and Silver Performance Achievement Award Winning Hospitals in USNWR Advertisement Mission: Lifeline Gold, Silver and Bronze Receiving and Silver, and Bronze Referring Achievement Award Winning Hospitals in USNWR Award Winning Hospitals on Get With The Guidelines myhealthcare and quality websites
21 Key Elements to Quality Improvement 1. Access to current and accurate data on treatment and outcomes 2. Physician champion, support among clinicians 3. Have stated goals 4. Administrative support 5. Use of pre-printed orders, care maps 6. Use of data to provide feedback
22 Conclusions AHA GWTG A large treatment gap between guidelines and practice exists for cardiovascular disease and as a result large number of patients are having recurrent fatal and non-fatal events that could have been prevented Performance improvement programs like GWTG can significantly increase the utilization of evidence-based, guideline recommended therapies and as a result reduce death and disability due to cardiovascular disease The AHA GWTG program is now undergoing International Implementation and will help improve the quality of care and clinical outcomes for patients with cardiovascular disease in Brazil
23 Improving Cardiovascular Care in China CSC/AHA CCC Program Initiated September 2014
24 CCC Nursing Survey Response RESULTS 39% (59/150) Hospitals Responding Clinical Pathways 49% (29/59) clinical pathway for ACS 69% (20/29) Specific for AMI 72% (21/29) electronic, 28%(8/29) paper 41% (24/59) clinical pathway for HF 71% (17/24) electronic, 29% (7/24) paper Health Education 71% (42/59) 100% patients received Health Education during Hospital stay 2% (2/59) < 50% received health education 44% (26/59) Educational Materials Provided by the Hospital 53% (31/59) Educational Materials from Hospital & Pharmaceutical Companies 2% (1/59) Only educational materials from pharmaceutical Companies
25 CCC Nursing Study: Research Questions 1- Are the Clinical Pathways for ACS, HF and AF the same? If not, how do they differ? 2- Are the Educational Pathways for ACS, HF and AF the same? If not how do they differ? 3- Should CCC standardize Clinical Pathways & Educational Materials? 4- Should Nursing Education be provided by specialized nurses or the general nursing team? 5- Are Teach Back Techniques used in all patient education? 6- Should patients be involved in development of Educational Materials? 7- Would it be helpful to have a Patient Advisory Board for CCC?
26 Senior Management Group Hcor: Dr. Bernardete Weber, Philanthropy Director Dr. Carlos Buchpiguel, Medical Director Dr. Otavio Berwanger, Director, Research Institute Ministry of Health Dr. Antonio Luiz Pinho Ribeiro Brazilian Society of Cardiology Dr. Angelo Amato V. de Paola, President Dr. Fernanda Consolim M. Colombo, Research Dir. American Heart Association Dr. Sidney C. Smith, AHA Volunteer Dr. Anne B. Curtis, AHA Volunteer Project Management Group HCor Erica Moura RN, Study Coordinator, Ligress Dr. Suzana Alves, Physician Researcher, Ligress Dr. Sabrina Bernardez, Physician Researcher, Ligress Dr. Fabio Taniguchi, Principle Investigator, Ligress Brazilian Society of Cardiology Danielle Rodrigues, Research Coordinator Rodolfo Vieira, General Manager American Heart Association Louise Morgan, MSN, Dir. International QI 10/15/ , American Heart Association 26
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