Comprehensive Coronary Artery Disease Care in a Safety-Net Hospital: Results of Get With The Guidelines Quality Improvement Initiative

Abstract

RESEARCHBACkGRouND: Adherence to published coronary artery disease (CAD) guidelines is suboptimal, particularly among minorities and the poor. While hospital-based quality-improvement programs may increase the use of evidence-based therapies, little data exist regarding the impact of such programs in sociodemographically disadvantaged (vulnerable) populations. Vulnerable patients in the united States are cared for primarily within the safety-net health system, which comprises urban public hospitals and outpatient community health centers. Denver Health is an example of an integrated system that encompasses both types of facilities.

Regional Systems of Care for Patients With ST-Elevation Myocardial Infarction

“…It is not surprising that healthcare systems and hospitals across the country are examining their standards of care and organizing quality improvement initiatives to decrease time to treatment and increase adherence to evidence-based therapies for patients with STEMI. 5,6 In this issue of Circulation, 2 pioneering model regional approaches that use integrated systems of care to increase the number of STEMI patients with timely access to a PCI facility are reported.…”

“…It is not surprising that healthcare systems and hospitals across the country are examining their standards of care and organizing quality improvement initiatives to decrease time to treatment and increase adherence to evidence-based therapies for patients with STEMI. 5,6 In this issue of Circulation, 2 pioneering model regional approaches that use integrated systems of care to increase the number of STEMI patients with timely access to a PCI facility are reported.Based on the premise that primary PCI is superior to fibrinolysis even when transfer from a non-PCI-capable facility to a primary PCI center is necessary, Henry and colleagues 7 developed a PCI-based treatment system with an integrated transfer program for STEMI patients at 30 hospitals within 210 miles from the Minneapolis Heart Institute at Abbott Northwestern Hospital. Participating hospitals were divided into zone 1 (Ͻ60 miles) and zone 2 (60 to Յ210 miles) from the Minneapolis Heart Institute.…”

Physical Activity, Weight Loss, and Cardiac Rehabilitation to Reduce Recurrent Cardiovascular Events

“…1), nonpharmacologic interventions (i.e., regular exercise program, smoking cessation, nutritional counseling, weight reduction) are often overlooked and underemphasized. Recent data from facilities implementing the American Heart Association's "Get with the Guidelines" quality improvement program showed nonpharmacologic interventions were utilized 26% to 54% of the time as compared with drug therapy, which was prescribed 86% to 93% of the time [44]. Accordingly, health care professionals must take a more active role in counseling their coronary patients regarding the independent and additive benefits of lifestyle modification to complement pharmacotherapies in reducing the risk of recurrent cardiovascular events.…”

Intervention to Increase the Proportion of Acute Myocardial Infarction or Coronary Artery Bypass Graft Patients Receiving an Order for Aspirin at Hospital Discharge

“…7 Previous reports have described improvement in the rates of compliance with several quality indicators for CAD using broad quality enhancement initiatives such as the ACC's Guidelines Applied in Practice (GAP) program, the AHA's Get with the Guidelines program, and the CRUSADE initiative. 8,9,10,11 Vasaiwala et al (2007) described a moderate increase in nearly all indicators of quality of care for AMI using the ACC's GAP program, with a specific increase in the discharge rate of aspirin from 86.5% in a pre-implementation period from January 1999 through June 2002 to 92.1% in a post-implementation period from July 2002 through December 2004. 8 Similarly, in a study reporting results from the Cooperative Cardiovascular Project, which used peer review organizations, hospital self-measurement tools, and systematic changes, there were improvements in 5 of 8 indicators of quality of care for AMI from a baseline period in 1992 to a post-intervention period in 1995.…”