|
Secondary Prevention of Heart Attack / Heart Disease
Secondary Prevention of Heart Attack / Heart Disease
|
Secondary
Prevention of Heart
Attack/Heart Disease
QIO’s
have led the way in
devising effective
programs to improve
performance measures
for the prevention
of secondary heart
attacks. QIO-provider
projects to improve
care for heart attack
patients save thousands
of lives a year. Some
examples:
- Four
QIOs (Alabama,
Connecticut, Iowa,
and Wisconsin) worked
jointly on the Cooperative
Cardiovascular Project
(CCP), which laid
the groundwork for
the first national
provider-based project
to prevent secondary
heart attacks in
the elderly. By providing
baseline data and
requesting improvement
plans, QIOs and collaborating
hospitals were able
to stimulate significant
improvements in all
areas of care. Highlights
included an increase
in in-hospital use
of aspirin for appropriate
patients from 84%
to 90% and the prescription
of beta-blockers
at discharge from
47% to 68%. These
improvements were
associated with a
10% reduction in
30-day and one-year
mortality rates in
these states. At
follow-up, performance
on all quality indicators
except reperfusion
experienced a greater
degree of improvement
in the pilot states
than in the rest
of the nation. At
one year after heart
attack, mortality
rates for pilot states
dropped to nearly
one percentage point
below the rest of
the nation.
- The
Oklahoma Foundation
for Medical Quality,
the Oklahoma QIO,
worked with VHA Oklahoma/Arkansas
Inc. and its 22 member
hospitals as a part
of the CCP/AMI Project.
The initiative resulted
in significant improvements
in door-to-drug time
for aspirin (from
240 to 5 minutes),
beta- blockers (from
24.5 to 4.9 hours),
and thrombolysis
(144 to 37 minutes).
Rates of smoking
cessation counseling
and beta-blockers
prescribed at discharge
both increased from
33% to 100% of eligible
patients, while aspirin
prescribed at discharge
increased from 77%
to 100% of eligible
patients.
- MassPRO,
the Massachusetts
QIO, has teamed with
the American Heart
Association to create
a national initiative,
Get With The Guidelines,
to improve the care
of patients hospitalized
with cardiovascular
disease. In the pilot
phase, MassPRO partnered
with 12 Massachusetts
groups including
the New England Affiliate
of the American Heart
Association and the
Massachusetts Chapter
of the American College
of Cardiology. Over
a 12-month period,
treatment rates rose
from 48% to 87% for
smoking cessation
counseling, 54% to
79% for lipid lowering
therapy, 59% to 79%
for LDL measurement,
60% to 68% for blood
pressure control,
and exercise counseling
rates or referral
to cardiac rehabilitation
rates rose from 34%
to 73%. This project
continues in Massachusetts
and has become a
national initiative
of the American Heart
Association, which
is partnering with
QIOs in a number
of states. The pilot
data will appear
in the Archives
of Internal Medicine
in 2003.
- The
Alabama Quality Assurance
Foundation, the
Alabama QIO, worked
with 20 hospitals
and cardiovascular
surgery teams to
significantly improve
the care of patients
undergoing coronary
artery bypass grafting
(CABG) surgery. Key
results include:
the percent of patients
who had breathing
tubes removed after
surgery within six
hours increased from
9% to 41.2%; the
use of internal mammary
artery grafts increased
from 73% to 84%,
and aspirin use at
discharge increased
from 88% to 92%.
These improvements
were associated with
a statistically significant
reduction in risk-adjusted
mortality.
- Primaris
worked with five
hospital emergency
departments to improve
the treatment of
patients with heart
attacks following
an error that resulted
in a patient’s death.
The Missouri QIO
established a collaborative
that required participants
to administer aspirin
within 20 minutes
of a patient’s arrival.
Following meetings
and conference calls,
timely aspirin administration
occurred 92% of the
time, compared to
14% prior to the
collaborative, and
the average amount
of time it took for
emergency room staff
to administer the
medication dropped
from 33 minutes to
14 minutes. Also,
Primaris worked
with 113 of 114 acute
care hospitals in
Missouri to improve
smoking cessation
counseling rates
in patients diagnosed
with MI. This care
indicator rose 16%
during the last three
years, wtih more
than half of the
hospitalized Medicare
patients diagnosed
with MI receiving
counseling.
- The
Georgia Medical Care
Foundation, the
Georgia QIO, manages
a series of multi-faceted,
statewide clinical
quality improvement
initiatives in which
approximately 67%
of Georgia’s acute
care providers are
now participating.
One of these initiatives
focused on providing
technical, consultative,
and educational support
to hospitals to improve
systems of care heart
attack patients.
Since 1998, GMCF
has seen an overall
improvement of 16%
in the key indicators
related to AMI. To
respond to requests
by small and/or rural
hospitals that triage
and transfer heart
attack patients from
the emergency department,
GMCF also developed
an abbreviated software
application. Twelve
smaller hospitals
are using this tool,
along with other
GMCF consultative
services, to improve
care to AMI patients.
- The
Michigan Peer Review
Organization,
the Michigan QIO,
collaborated with
the American College
of Cardiology, and
31 hospitals, in
three ACC AMI Guidelines
Applied in Practice
(GAP) projects. The
projects showed that
the use of a standardized
order form resulted
in significantly
higher rates for
early aspirin and
LDL cholesterol measurements,
and the use of an
AMI standard discharge
form demonstrated
significant improvement
in aspirin, beta-blocker,
smoking cessation
counseling, dietary
counseling and cholesterol
lowering treatment
at discharge. The
results of the AMI
GAP projects demonstrate
that adherence to
guideline-based therapy
is enhanced when
there are AMI-specific
standard orders and
discharge tools,
focused implementation
strategies, quality
improvement support,
and high expectations
of the hospital team.
- QSource
worked closely
with the American
Heart Association
to promote the "Get
with the Guidelines"
national initiative
to hospitals in our
state. QSource helped
18 Tennessee hospitals
gain national recognition
for their efforts
and worked with other
collaborators to
improve care and
outcomes for heart
attack patients.
These improvement
efforts were associated
with a 7% absolute
improvement in early
administration of
beta-blockers, and
a 9% absolute improvement
in beta-blocker at
discharge.
- The
Kansas Foundation
for Medical Care
conducted extensive
efforts statewide
to improve utilization
of beta-blockers
after a heart attack.
These efforts included
multiple visits with
individual hospitals,
sharing of quality
improvement success
stories, educational
programs, and a series
of "rapid cycle"
quality improvement
programs to improve
heart attack care.
Statewide, over the
past three years,
Kansas has experienced
a 20% increase in
use of beta-blockers
after a heart attack.
In the most recent
rapid-cycle quality
improvement effort,
15 hospitals working
on heart attack care
reported that 90%
of eligible heart
attack patients were
discharged on beta-blockers.
- IPRO
used an intense,
multi-faceted intervention
approach to improve
quality of care for
Medicare beneficiaries
with Congestive Heart
Failure. Along with
standard educational
approaches, IPRO
worked with more
than 50 hospitals
to provide on-site
audit and feedback
services. The on-site
audits focused not
only on the quality
indicators, but also
on putting processes
and systems in place
that could help providers
improve their performance.
In addition, IPRO
created a web site
that allowed providers
direct access to
reports, educational
materials, best practices
information, and
even free online
CME credits. These
activities helped
New York state improve
performance on CHF
indicators by 6%
over the SOW6.
- The
Carolina Medical
Review’s collaborative
approach, or Fast
Track Feedback, encouraged
South Carolina hospitals
to adopt a Plan,
Do, Study, Act methodology
for monitoring and
evaluating patient
care. Nearly all
of South Carolina’s
acute care hospitals
participated in this
effort, which was
applied to examining
care processes for
elderly patients
with heart failure
and AMI, and to exploring
ways to improve processes
to achieve better
outcomes. As a result
of CMR’s efforts,
all of South Carolina’s
acute care hospitals
worked on heart failure,
which resulted in
overall improvement
in all quality indicators.
Nearly all of the
participating hospitals
worked on AMI and
also showed great
improvement in all
indicators.
- Stratis
Health worked
with the state rural
health agency to
develop and offer
a collaborative project
for Minnesota's first
10 Critical Access
Hospitals, focusing
on heart failure
and atrial fibrillation.
The project used
four in-person learning
workshops over 10
months starting in
December 2001, with
support, contact,
and action between
each workshop. In
heart failure, 50%
of the hospitals
showed improvement
in the availability
of LVF data, and
75% demonstrated
improvement in patient
education. In atrial
fibrillation, 50%
showed improvement
in some or all of
the areas. Based
on the success of
this project, Stratis
Health is launching
a second Critical
Access Hospital collaborative,
for up to 30 hospitals,
in March 2003.
- The
Colorado Foundation
for Medical Care's
Inpatient Team established
an outreach program
consisting of semi-annual
regional hospital
meetings for hospitals
to present ongoing
quality improvement
projects to one another.
In addition, CFMC
presents clinical
informational updates
and data feedback.
CFMC also produced
a resource notebook
containing examples
of pathways and standing
orders, which are
successfully being
used in Colorado
hospitals. A large
number of Colorado
hospitals have chosen
acute myocardial
infarction and heart
failure core measures
and frequently request
information on these
topics. Through CFMC
facilitation of these
regional meeting,
hospitals took necessary
steps in systems
change for both AMI
and HF care in Colorado.
Over the last three
years Colorado hospitals
have accomplished
an overall relative
improvement of 15%.
- The
Delmarva Foundation
for Medical Care,
Maryland and District
of Columbia QIO,
helped seven (15%)
of Maryland’s acute
care hospitals raise
their performance
rates to 90% or better
on at least 6 of
13 quality indicators
during 2001 and 2002.
These hospitals received
Delmarva’s Campaign
for Medicare Excellence
Award for improving
the timing of medications
for people suffering
from heart attacks,
and for ensuring
that correct medications
were prescribed for
patients treated
for various heart
conditions. The hospitals
achieved their performance
gains through a combination
of enhanced communication,
increased accountability,
ongoing data collection,
data analysis and
feedback. Hospitals
chosen for the award
also maintained their
rate of excellence
for a minimum of
six months. The award
program successfully
stimulated interest
in working with the
Delmarva to improve
clinical performance.
- Information
and Quality Healthcare,
the Mississippi QIO,
worked with 70 hospitals
to promote system
changes to standardize
processes for AMI
care. Physician education
and components of
the project were
extended to the outpatient
setting and clinics
by the hospitals.
Collaborators, also
including associations,
agencies and coalitions,
worked to reduce
cardiovascular disease
occurrence in the
state. IQH's Tobacco
Quitline Mississippi,
a smoking cessation
counseling service,
provided vital support
for the AMI project
by highlighting the
importance of smoking
cessation counseling
in the state.
- MetaStar,
the Wisconsin QIO,
joined with five
Wisconsin business
coalitions to successfully
reduce unnecessary
use of bilateral
heart catheterizations.
Encouraged by the
success of this project,
MetaStar has joined
with one of the coalitions
and the Wisconsin
Diabetes Control
Program in a program
to encourage more
appropriate use of
preventive, screening,
and clinical services
for patients with
diabetes.
|
|
