We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byAlejandro McGregor
Modified over 2 years ago
© 2010, American Heart Association. All rights reserved. Are Quality Improvements Associated with the GWTG-Coronary Artery Disease (GWTG-CAD) Program Sustained Over Time? A Longitudinal Comparison of GWTG-CAD Hospitals vs. non--GWTG-CAD Hospitals Ying Xian, MD; Wenqin Pan, PhD; Eric D. Peterson, MD, MPH; Paul A. Heidenreich, MD, MS; Christopher P. Cannon, MD; Adrian F. Hernandez, MD, MHS; Bruce Friedman, PhD, MPH; Robert G. Holloway, MD, MPH; Gregg C. Fonarow, MD Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Background Previous reports have demonstrated that participation in Get With The Guidelines-- Coronary Artery Disease (GWTG-CAD), a national quality initiative of the American Heart Association, is associated with improved guideline adherence for patients hospitalized with CAD. We sought to establish whether these benefits from participation in GWTG-CAD were sustained over time. Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Introduction The American Heart Association (AHA) and the American College of Cardiology (ACC) have developed treatment guidelines for patients with coronary artery disease (CAD). Despite widely available evidence-based therapies that have been shown to improve clinical outcomes for patients with coronary artery disease (CAD), a treatment gap exists between clinical practice and use of guideline-recommended therapies. GWTG-CAD quality improvement program has shown significant improvements in guideline adherence for patients hospitalized with CAD. Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Objective The GWTG program is the largest hospital-based, national performance initiative that has shown to improve adherence to treatment guidelines over a 1-year period for participating hospitals. The purpose of this paper was to evaluate whether guideline adherence for patients hospitalized with CAD was sustained over time. Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Methods The Centers for Medicare and Medicaid (CMS) Hospital Compare Database was used to examine six performance measures and one composite score over 3 consecutive 12-month periods including aspirin and β-blocker on arrival/discharge, ACE-I for LVSD, and adult smoking cessation counseling. The differences in guideline adherence between the GWTG-CAD hospitals (n=440, 439, 429) and non--GWTG- CAD hospitals (n=2438, 2268, 2140) were evaluated for each 12-month period. A multivariate mixed-effects model was used to estimate the independent effect of GWTG-CAD over time adjusting for hospital characteristics. Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Results Compared with non--GWTG hospitals, the GWTG-CAD hospitals demonstrated higher guideline adherence for 6 performance measures. The largest differences existed for (1) aspirin at arrival (2.3%, 2.1%, and 1.6% for each 12-month period, respectively) (2) aspirin at discharge (3.4%, 2.2%, and 2.3%) (3) β-blocker at arrival (3.4%, 2.9%, and 2.6%), and (4) β-blocker at discharge (2.8%, 1.8%, 1.5%). In multivariate analysis, the GWTG-CAD hospitals were independently associated with better adherence for 4 of the 6 measures (the exceptions were ACE-I for LVSD and smoking cessation counseling). Superior performance also was found for the composite measures. Although there was some narrowing between groups, GWTG-CAD 4 hospitals maintained superior guideline adherence than non--GWTG- CAD hospitals over the entire 3-year period (adjusted differences 1.8%, 1.6%, and 1.4%). Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Limitations Too few hospitals newly joined the GWTG-CAD during the study period to allow a pre-and-post evaluation of performance changes after the GWTG-CAD implementation using the CMS Hospital Compare Database. This study did not control for the patient case mix; however performance measure assessment was confined only to eligible patients without contraindications. Because program participation is voluntary it was hard to establish if participation in the GWTG-CAD program resulted in improved adherence or if higher quality hospitals participate in GWTG-CAD. Other factors such as pay for performance, public reporting, or other quality initiatives may have influenced the performance measures because information on these factors was not available in the CMS Hospital Compare Database. Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Conclusions Hospitals participating in GWTG-CAD had modestly superior acute cardiac care and secondary prevention measures performance relative to non--GWTG-CAD. These benefits of GWTG-CAD participation were sustained over time and independent of hospital characteristics. As substantial care opportunities in patients hospitalized with coronary artery disease remain unfulfilled, expanding GWTG-CAD participation nationwide has the potential to increase guideline adherence and enhance patient outcomes. Xian et al. Am Heart J 2010;159(2):
© 2010, American Heart Association. All rights reserved. Hospital Performance Recognition with the Get with the Guidelines Program and Mortality for Acute.
© 2010, American Heart Association. All rights Association of Hospital Primary Angioplasty Volume in ST-Segment Elevation Myocardial Infarction With Quality.
© 2010, American Heart Association. All rights reserved. Evolving Patterns of Use and Appropriateness of Aldosterone Antagonists in Heart Failure Nancy.
© 2010, American Heart Association. All rights reserved. A Validated Risk Score for In-hospital Mortality in Patients with Heart Failure from the American.
Ovbiagele et al. Epub May 27, Stroke. Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients with Stroke Bruce Ovbiagele,
Associations Between Outpatient Heart Failure Process of Care Measures and Mortality Gregg C. Fonarow, Nancy M. Albert, Anne B. Curtis, Mihai Gheorghiade,
Saver et al. Epub June 3, 2010 STROKE The Golden Hour and Acute Brain Ischemia: Presenting Features and Lytic Therapy in Over 30,000 Patients Arriving.
FUTURE OF HEALTH CARE WORKGROUP TEXAS HEALTH INSTITUTE AUSTIN, TEXAS Thursday, May 10, 2012.
Journal Club Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital 9/12/2010 Nir Hus MD., PhD. Ryder Trauma Center Jackson Memorial Hospital.
Evidence guiding health care. Source Kapral MK, Hall RE, Silver FL, Robertson AC, Fang J. Registry of the Canadian Stroke Network. Report on the 2004/05.
1 The Long-Term Financial Outlook for Healthcare and CMS Research Agenda: Searching for Magic Bullets Bill Saunders, Deputy Director Office of Research,
Secondary prevention of MI. Sep 2003Dr. Sooraj Natarajan Ischaemic heart disease May be broadly defined to include Myocardial infarction Myocardial infarction.
Introduction to Patient Safety Research Presentation: Developing Solutions: Cluster Randomized Clinical Trial.
Improving Evidence-Based Care for Heart Failure in Outpatient Cardiology Practices: Primary Results of the Registry to Improve Heart Failure Therapies.
Research into Process and Outcome of Art Therapy Claire Edwards Tom OBrien Robert King.
An audit of the antithrombotic therapy for the management of valve repair or replacement Gellatly RM 1,2, Maydelmin D 1, Connell C 1, Marasco S 3, Zimmet.
Impact of an antidepressant adherence program in a managed care organization Kara Zivin Bambauer, PhD Stephen Soumerai, ScD Alyce Adams, PhD Fang Zhang,
A Guideline for Healthcare Professionals From the American Heart Association & American Stroke Association Metrics for Measuring Quality of Care in Comprehensive.
AHA/ASA Guideline Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals.
Depression Care: Implementing Integrated Primary Care- Behavioral Health Solutions Mark Dreskin, MD Depression Care Program Southern California Kaiser.
The Application of Propensity Score Analysis to Non-randomized Medical Device Clinical Studies: A Regulatory Perspective Lilly Yue, Ph.D.* CDRH, FDA, Rockville.
Achieving Equality in Health and Social Care for Older People: Opportunities and Challenges Nat Lievesley Centre for Policy on Ageing December 2013 Evidence.
Pay-for-Performance Programs: the U.S. Experience Eric Schneider, M.D., M.Sc. Harvard School of Public Health Brigham and Womens Hospital Boston, MA.
In the name of GOD. Sara Sadri case scenario A 50 years old woman who is known case of diabet type 2 with uncontrolled diabet despite use of metformin.
Psychological Flexibility and ACT in the Workplace: Understanding and Improving Health and Performance Jo Lloyd, PhD BABCP ACT Special Interest Group.
1 Use of Cochrane review results in designing new studies Nicola Cooper Centre for Biostatistics and Genetic Epidemiology, University of Leicester UK
DOES TRAINING VOUCHER HELP INCREASE INCOME OF REDUNDANT WORKERS OF RESTRUCTURED SOES IN VIETNAM? Lan Anh Vu Central Institute for Economic Management Vietnam.
Prevalence and Predictors of Off-label Use of Cardiac Resynchronization Therapy: A Report from the ICD Registry TM Adam S. Fein * MD, Yongfei Wang ¥ MS,
Measuring the Effects of Unit Nonresponse in Establishment Surveys Clyde Tucker and John Dixon U.S. Bureau of Labor Statistics David Cantor Westat.
Appraisal of an RCT using a critical appraisal checklist Spink MJ, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community.
© 2016 SlidePlayer.com Inc. All rights reserved.