Unperceived treatment gaps in acute coronary syndromes

Huynh, Luan; Chew, Derek P.; Sladek, Ruth; Phillips, Paddy A.; Brieger, David; Zeitz, Chris

doi:10.1111/j.1742-1241.2009.02182.x

Cited by 17 publications

(15 citation statements)

References 21 publications

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“…It has been suggested that variation in compliance to recommended processes of care may reflect differences in training, guideline familiarity, and implementation of tools and systems to ensure that recommended care is provided and documented [22], [23]. Indeed, another factor affecting the adherence to quality indicators may be the impaired perception about connection of evidence-based processes of care to improved outcomes [6], [8], [24], [25]. Two surveys conducted by some of us among Italian physicians documented that, despite a general agreement towards the need to integrate clinical practice and the best available evidence, they not frequently used results of economic evaluations, RCTs and meta-analyses to make decisions in the clinical practice [26].…”

Section: Discussionmentioning

confidence: 99%

Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy

et al. 2012

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ObjectivesThe main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines.MethodsA retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care.ResultsA total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP.ConclusionsThe results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care.

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Section: Discussionmentioning

confidence: 99%

Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy

et al. 2012

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“…Clinicians often have false beliefs about their level of guideline implementation [72]. Cardiac networks can play an important role in auditing quality of care and monitoring continuing improvement performance measures.…”

Section: Access To Healthcarementioning

confidence: 99%

Challenges and solutions in medically managed ACS in the Asia-Pacific region: Expert recommendations from the Asia-Pacific ACS Medical Management Working Group

Huo

Thompson

Buddhari

et al. 2015

International Journal of Cardiology

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“…Translation of knowledge into practice has been identified as a major practice‐related issue affecting quality of ACS care 6 . In a 2009 survey, Australian clinicians reported high levels of agreement with, and adherence to, the existing (2006) ACS guidelines.…”

Section: Practice‐related Factorsmentioning

confidence: 99%

“…Translation of knowledge into practice has been identified as a major practice-related issue affecting quality of ACS care. 6 In a 2009 survey, Australian clinicians reported high levels of agreement with, and adherence to, the existing (2006) ACS guidelines. However, these views correlated poorly with observed practice, with often striking overestimation by clinicians of their use of treatments recommended in the guidelines.…”

Section: Practice-related Factorsmentioning

confidence: 99%

“…However, these views correlated poorly with observed practice, with often striking overestimation by clinicians of their use of treatments recommended in the guidelines. 6 Clinician misperception about patient risk of recurrent cardiovascular events and uncertainty about applying evidence for patients with complex clinical needs appear to be contributors to the variation. Cardiovascular risk stratification is a critical decision point in the appropriate provision of cardiac care.…”

Section: Practice-related Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical care standards: appropriate care everywhere — acute coronary syndromes as an example

Chew

Herkes

Page

2016

Medical Journal of Australia

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Summary Audit data show that despite clinical practice guidelines, some patients miss out on evidence‐based care, which is not explained by individual needs or preferences. Clinical care standards are small sets of concise recommendations that focus on known gaps in evidence‐based care for a particular clinical condition. They aim to ensure that all patients with the same clinical condition are offered appropriate care, regardless of their location. Clinical care standards are nationally agreed standards and are developed to maximise engagement of consumers, clinicians, health services, and state and territory health departments and agencies. They complement clinical practice guidelines and other initiatives for improving quality of health care. As an example, the Acute Coronary Syndromes (ACS) Clinical Care Standard is a significant step forward in supporting clinicians and health services to realise all of the gains promised by the ACS evidence base. The ACS Clinical Care Standard focuses on the areas of care that are known to be most associated with variation in outcome. It supports patient involvement in critical decisions that affect their care, refocuses clinicians on the priority areas of ensuring appropriate ACS care, and informs health services about the systems required to deliver evidence‐based care.

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Unperceived treatment gaps in acute coronary syndromes

Cited by 17 publications

References 21 publications

Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy

Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy

Challenges and solutions in medically managed ACS in the Asia-Pacific region: Expert recommendations from the Asia-Pacific ACS Medical Management Working Group

Clinical care standards: appropriate care everywhere — acute coronary syndromes as an example

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