closing the chd treatment gap saving lives through better implementation of secondary prevention...
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Closing the CHD Closing the CHD Treatment GAPTreatment GAP
Saving Lives Through Better ImplementationSaving Lives Through Better Implementationof Secondary Prevention Measuresof Secondary Prevention Measures
The Impact of Coronary Heart The Impact of Coronary Heart Disease in the United StatesDisease in the United States
14 million Americans alive today have a history of myocardial infarction, angina, or both.1
450,000 recurrent myocardial infarction occur each year, most of which could have been prevented
25% of men and 38% of women will die within 5 years of presenting with a AMI2
Studies suggest that a large number of CAD patients do not receive the therapies that can prevent recurrent events and save lives 3-5
1 AHA Heart and Stroke Facts: 1996 Statistical Supplement2 Rossouw, et al., N Engl J Med, 323:1112-1119.19903 Cohen, et al., Circulation, 83(4):1294-1304, 19914 Nieto, et al., Arch Intern Med, 155:677-684, 19955 Giles, et al., JAMA, 269 (9):1131-1138, 1993
AHA/ACC Guidelines to Risk Reduction AHA/ACC Guidelines to Risk Reduction For Patients With CHD and Other Vascular DiseaseFor Patients With CHD and Other Vascular Disease
Cessation of smokingCessation of smoking Lipid Management GoalsLipid Management Goals Primary Goal: LDL < 100 mg/dl Primary Goal: LDL < 100 mg/dl Secondary: HDL > 35 mg/dl TG < 200 mg/dl Secondary: HDL > 35 mg/dl TG < 200 mg/dl Physical activity: 30 minutes 3-4 times per weekPhysical activity: 30 minutes 3-4 times per week Weight managementWeight management Antiplatelet/anticoagulants:ASA 80 to 325 mg/day Antiplatelet/anticoagulants:ASA 80 to 325 mg/day (or warfarin)(or warfarin) ACE inhibitors (post-MI for LVD)ACE inhibitors (post-MI for LVD) Beta blockers for high-risk patients post-MI Beta blockers for high-risk patients post-MI Blood pressure control: goal Blood pressure control: goal << 140/90 mm Hg 140/90 mm Hg
Adapted from Smith, Circulation 1995;92:3Adapted from Smith, Circulation 1995;92:3
Comprehensive Medical Therapy For Patients Comprehensive Medical Therapy For Patients with CHD or Other Vascular Diseasewith CHD or Other Vascular Disease
Adapted from the UCLA CHAMP Guidelines 1994Adapted from the UCLA CHAMP Guidelines 1994
Risk ReductionRisk Reduction
ASA 20-30% Beta Blockers 20-35% ACE inhibitors 22-25% Statins 25-42%
The four medications every atherosclerosis patient should be treated with, unless contraindications exist and are documented
““Despite compelling scientific evidence and Despite compelling scientific evidence and national treatment guidelines supporting the national treatment guidelines supporting the use of secondary prevention medical use of secondary prevention medical therapies, these treatments continued to be therapies, these treatments continued to be underutilized in CVD patients receiving underutilized in CVD patients receiving conventional care” conventional care”
Adapted from 27th Bethesda Conference Report JACC 1997;27:958
Provider awareness does not equal successful implementation
Pearson Arch Intern Med 2000;160:459-67
CAD Treatment Gap - CommunityCAD Treatment Gap - Community
Physician Awareness of NCEP Guideline
Patient Treatedto Goal
95
18
0
20
40
60
80
100
An academic environment does not equal successful implementation
CAD Treatment Gap - Academic CentersCAD Treatment Gap - Academic Centers
Brigham and Women’s Hospital: 2003 outpts with CAD Arch Intern Med 2001:161:53-58LDS Hospital: 600 CAD patients discharged post cath Am J Card 2001;87:256-261Cleveland Clinic: 537 Diabetics with CAD Post PTCA JACC 1999;33:1269-77PURSUIT Trial Centers: 8515 ACS patients JACC 2000;35:411A
27.118 14.9
25.1
0
20
40
60
80
100P
rec
en
t o
f P
at i
en
t s T
rea
t ed
TheBrigham
LDSHospital
ClevelandClinic
PURSUITTrial Centers
Lipid Lowering Medication Treatment Rates
Quality Assurance Program (QAP)Quality Assurance Program (QAP)
No LDL-CDocumented“No Therapy”
43%
At GoalAt Goal““On Therapy”On Therapy”
7%7%At GoalAt Goal
““No Therapy”No Therapy”4%4%
Not at Goal“On Therapy”
18%
Not at Goal“No Therapy”
14%No LDL-C
Documented“On Therapy”
14%
n = 48,586n = 48,586
Sueta C, et al. Am J Cardiol. 1999;83:1303-1307.
CAD Treatment Gap - HospitalCAD Treatment Gap - Hospital
ACC Evaluation of Preventive Therapeutics (ACCEPT) Data - Hospital data (N=50) 1996-97
Treatment Gap of 80 % Treatment Gap of 80 % NRMI 3 Data - 1998-1999
32 % of Post-MI patients discharged on a lipid lowering agent 32 % of Post-MI patients discharged on a lipid lowering agent (N = 138,001) (N = 138,001)
Treatment gap is not a deficit of knowledge, rather it is a deficit of implementation
Pearson, T.A. et al., Supplement to Circulation: Oct, 1997;96:8:1733Fonarow Circulation 2001;103:38-44.
ACCEPT: Most Hospitalized CHD Patients are Not ACCEPT: Most Hospitalized CHD Patients are Not at Goal 6 Months Post Discharge at Goal 6 Months Post Discharge
Risk Factor GoalRisk Factor Goal OnOnAdmissionAdmission
At DischargeAt Discharge 6 mo. Post6 mo. PostDischargeDischarge
LDL-C < 100mg/dLLDL-C < 100mg/dL 0%0% 0%0% 24%24%
Lipid Lowering DrugLipid Lowering Drug 21%21% 24%24% 59%59%
AspirinAspirin 44%44% 86%86% 87%87%
Beta BlockerBeta Blocker 34%34% 58%58% 63%63%
Pearson, T.A. et al., Supplement to Circulation: Oct, 1997;96:8:1733.
68.3%
31.7%
No Lipid Lowering Lipid Lowering
138,001 patients discharged post AMI from 1470 US hospitals, July 1998 to June 1999Fonarow Circulation 2001;103:38-44
Independent Predictors
Teaching Hospital
Smoking Cessation
Catheterization
Use of Beta Blocker
CABG
decreased increased
Utilization of Lipid-Lowering Medications Utilization of Lipid-Lowering Medications at Discharge in Patients with AMIat Discharge in Patients with AMI
138,001 Patients in the National Registry of Myocardial Infarction-3
"Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction" Fonarow Circulation 2001;102:38-44
<55 55-64 65-74 75-84 85+
Age (Years)
0
20
40
60
80
100Male (N=83,806)
Female (N=54,195)
% D
isch
a rge
d on
Lip
id T
her a
py
P<0.0001 P<0.0001P<0.0001
P=NS
P=NS
Utilization of Lipid-Lowering Medications Utilization of Lipid-Lowering Medications at Discharge in Patients with AMIat Discharge in Patients with AMI
OFFICE SETTING
QAP DATA 30-40% Documented
Treatment Rate Treatment Gap of 66%
BURDEN OF DISEASE 23 million CHD patients in
the US
HOSPITAL SETTING
NRMI / ACCEPT DATA 20-32% Documented Treatment
Rate Treatment Gap of 68-80%
BURDEN OF DISEASE 2.7 million annual CHD discharges
in the US
CVD Treatment GapCVD Treatment Gap
National Hospital Discharge RatesNational Hospital Discharge Ratesfor Secondary Preventionfor Secondary Prevention
Report from 7/99 to 6/00NRMI Registry Discharge Medications at 1552 National NRMI III Hospitals (n=167,312)Includes all patients (no exclusions for contraindications or intolerance)
77
65
4237
42
ASA Beta blocker ACEI Statin Smoking0
20
40
60
80
100
Pe
rce
nt
of
Pa
tie
nts
Cessation
Physician is focused on acute problems
Time constraints and lack of incentives, including reimbursement
Lack of training including inadequate knowledge of benefits and lack of prescription experience
Lack of resources and facilities
Lack of specialist-generalist communication; passing on responsibility
Barriers to Implementing Risk Factor ManagementBarriers to Implementing Risk Factor Managementin Patients with Documented Coronary Artery Diseasein Patients with Documented Coronary Artery Disease
Adapted from 27th Bethesda Conference Report JACC 1997;27:958
Guidelines and treatment pathways which delay therapy and call for multiple steps, laboratory tests, and time points
Incentives for ChangeIncentives for Change NCQA/HEDIS/JCAHO/GOA reporting measures
– HospitalsHospitals
– Managed CareManaged Care
– PhysiciansPhysicians
Consumer demand for quality care / report cards
Graded on
– ASA after AMIASA after AMI
– Beta blocker after AMIBeta blocker after AMI
– ACEI after AMI and CHFACEI after AMI and CHF
– LDL evaluated/Rxed post cardiac hospitalizationLDL evaluated/Rxed post cardiac hospitalization
CVD Treatment System GoalsCVD Treatment System Goals
Implement initiatives to put evidence based guidelines into action
Improve the quality of care for patients with established cardiovascular disease
Reduce secondary events - and save lives
Optimal Hospital Discharge RatesOptimal Hospital Discharge Ratesfor Secondary Preventionfor Secondary Prevention
Indicator Rate Optimal
ASA 85%* 100%
Beta Blocker 72%* 100%
ACE-I 71%* 100%
Smoking Cessation 40%* 100%
Lipid Lowering 32%** 100%
*HCFA 1998 and **NRMI 1999
Optimal: UCLA Cardiology Performance Improvement Committee (patients without contraindications or medical intolerance)
Why a Hospital Based System?Why a Hospital Based System?Why a Hospital Based System?Why a Hospital Based System?
Patients–Patient Capture PointPatient Capture Point
–Have patients/family attention: “teachable moment’Have patients/family attention: “teachable moment’
–Predictor of care in communityPredictor of care in community Hospital Structure
–Standardized processes/protocols/orders/teamsStandardized processes/protocols/orders/teams
– JCAHOJCAHO• Process Improvement ExamplesProcess Improvement Examples
–HCFA--Peer Review OrganizationsHCFA--Peer Review Organizations• Six Scope of WorkSix Scope of Work
In-Hospital Initiation of Risk Factor In-Hospital Initiation of Risk Factor Modification and Cardioprotective TherapiesModification and Cardioprotective Therapies
Initiation of interventions for smoking cessation while patients are hospitalized with AMI has been shown to result in higher cessation rates then similar interventions initiated in the outpatient setting(1 year cessation rate of 71% vs 45%, P<0.01)
The UCLA Comprehensive Heart Failure Management Program demonstrated a 96% utilization rate of ACEI at 6 months when treatment was initiated at the time of hospitalization, a rate which was significantly higher as compared to conventionally managed outpatients
Taylor Annals Intern Med 1990;113:118-123Fonarow JACC 1997;30:725-732
CHD Patient Flow in the HospitalCHD Patient Flow in the Hospital
Lab
ER
Cath
ICU/CCU
Cardiology
Medicine
Telemetry
Pharmacy
QualityControl
DischargeNurse
InpatientRehab
6 Million
Discharged
2.7Million
OutpatientRehab
GroupPractice
10%
Cardiologist
Family Practice
LOST
Advocate/ChampionAdvocate/Champion
AcuteCoronary
Event
Inpatient Care
Outpatient Care
Protocol development process Implementation
Challenges to In-Hospital Initiation Challenges to In-Hospital Initiation of Lipid Lowering Treatmentof Lipid Lowering Treatment
BARRIERS1. Communication gaps - cardiologists vs
PCPs
2. Lack of ownership - acute vs chronic disease dilemma
3. Poor lab standardization and reporting
4. Lack of financial incentives
5. Lack of tools/resources
6. Lack of proof of concept
SOLUTIONS1. Education and mobilizing case management teams
2. Hospital is the capture point for patients with acute disease
3. Routine lipid testing for CHD patients by protocol
4. Joint Commission, NCQA, PROs will be measuring and reporting
5. HCFA - 6 scope of work, Joint Commission, ORYX are standardizing measurement tools
6. UCLA CHAMP demonstrates improved treatment rates and outcomes
the lipid panel in not accurate when drawn in the hospital
the primary care physicians will not agree to this
this will not work in a community hospital
the physicians at my hospital do not like cookbook medicine
the cardiologists will not agree to this
it may not be safe to start lipid lowering medications in hospitalized patients
the patients should all be followed in my lipid clinic
patients do not want to be on a lot of medications
the hospital administration will not pay for it
the managed care organization will not pay for it
we can not get a consensus
it will cost too much
we do not have anyone to collect this data
it will take too much time
it is too hard to get things through the hospital committee
this will benefit the competition
there is not enough time
there are exceptions x, y, and z
what about the liability
Challenges to a Hospital Based SystemChallenges to a Hospital Based System
Design of the UCLA Cardiovascular Hospitalization Design of the UCLA Cardiovascular Hospitalization Atherosclerosis Management Program :CHAMPAtherosclerosis Management Program :CHAMP
Based on hypothesis that physician use of and patient compliance with secondary prevention therapies could be improved with a hospital based treatment initiation program
Focused on initiation of aspirin, beta blocker, ACE inhibitor, and statin dosed to achieve LDL < 100 mg/dl in all cardiovascular disease patients prior to hospital discharge
Use of preprinted orders, simple guidelines, educational lectures, discharge forms, and prospective monitoring of treatment use.
Started in 1994 and continues to be the standard of care at UCLA
Fonarow Circulation 1997;96(8):I-67
AtherosclerosisCoronaryCarotidPeripheral
ClinicalUltrasoundStress TestAngiographic
Aspirin, Beta Blocker, ACEIHMG Co A Reductase Inhibitor
Exercise and Dietary Counseling
6 weeksFasting Lipid Panel, LFTs
LDL < 100 mg/dl
Continue TreatmentRecheck in 3-6 months
LDL > 100 mg/dl
Advance dose and/oradd niacin, resin
Recheck 6 weeks
CHAMP Fonarow Am J Cardiol 2000; 85:10A-17A
Admission Lipid Panel, LFTs
Hospital Phase of care
Outpatient Phase of care
CHAMP Algorithm for Patients with Clinically CHAMP Algorithm for Patients with Clinically Evident AtherosclerosisEvident Atherosclerosis
Focused TreatmentGuidelines and Algorithm
Preprinted AdmitOrder Sheets
Discharge Forms and Outpt F/U Process
Patient EducationMaterials
Focused Lecturesby Opinion Leader
Measurement andUtilization Reports
Implementation of CHAMPImplementation of CHAMP
Fonarow Circulation 1997;96(8):I-67
Admit patient to the CCU / COU
Attending ________ Resident ________ Intern _______
Vital Signs: Diet: 2 gm Na Step II AHA 4 gm Na Step II AHA
Laboratories: CK and CK-MB q 8 x 3, Troponin I now and 6 hours Lipid panel (nonfasting) TC, LDL, HDL, TG ECG now and q AM x ___
Medications: Aspirin 325 mg PO qd or ________________ Beta Blocker: Metroprolol ________ mg PO bid or __________ ACE Inhibitor: _________ ___ mg PO ___ HMG CoA RI: _________ ___ mg PO ___
Smoking cessation program Cardiac rehabilitation referral
UCLA Division of Cardiology
Patient ID #UCLA Chest Pain/Unstable Angina Orders
Standardized Admission Order SheetsStandardized Admission Order Sheets
UCLA Comprehensive AtherosclerosisTreatment Program Medication Goals
1) All patients with coronary, other vasculardisease, or diabetes treated with aspirin*
2) All patients with coronary, other vasculardisease, or diabetes treated with a statin*(dosed to achieve LDL < 100 mg/dl)
3) All patients with coronary, other vasculardisease, or diabetes treated with an ACEinhibitor*
4) All patients with coronary, other vasculardisease, or diabetes treated with a betablocker*
* unless contraindicated, not tolerated, or reason for not using documented in the medical record
Achieve TargetsLDL < 100 mg/dl
BP < 140/90 mmHgSmoking Cessation
LDL Treatment to Goal Guide
Baseline % reduction to goalLDL Level of LDL < 100 mg/dl115 mg/dl 13%120 mg/dl 17%125 mg/dl 21%130 mg/dl 24%140 mg/dl 29%150 mg/dl 34%160 mg/dl 38%170 mg/dl 42%180 mg/dl 45%190 mg/dl 48%
Simvastatin Lovastatin Atorvastatin10 mg 22% 10 mg 22% 10 mg 34%20 mg 31% 20 mg 25% 20 mg 41%40 mg 38% 40 mg 31% 40 mg 48%80 mg 45% 80 mg 41% 80 mg 51%
Pravastatin Cerivastatin Fluvastatin10 mg 20% 0.3 mg 30% 20 mg 20%20 mg 25% 0.4 mg 34% 40 mg 27%40 mg 30% 0.8 mg 42% 80 mg 32%
Visit www.med.ucla.edu/champ for further details 2001 CHAMP, UCLA Division of Cardiology
Implementation of CHAMPImplementation of CHAMP
8286
74
92
68
76
148
158
1622
UA Acute MI Chest pain PTCA CABG CHF0
20
40
60
80
100
120
Sta
tin
Ut i
liza
tio
n R
ate
(%
)
Admit Discharge
1779 patients hospitalized for coronary heart disease 1994-1995Fonarow Am J. Card. 2000; 85:10A-17A
Improved Treatment Utilization Across All Patient Categories
Impact of CHAMP on Treatment RatesImpact of CHAMP on Treatment Rates
The UCLA-CHAMP ExperienceThe UCLA-CHAMP Experience
CAD Patient Treatment Rates
*Fonarow, G. et al. “Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP,” Abstract #364 from the 70th Scientific Sessions, American Heart Association, November, 1997.
Proof of ConceptProof of Concept
‘92-’93(n=256)
‘94-’95(n=302)
Hospital discharge: Aspirin Beta-Blocker ACEI Statin12-month follow-up: Statin LDL < 100 mg/dL
78%12% 4% 6%
10% 6%
92%61%56%86%
91%58%
LDL Pre-CHAMP 92/93 Post-CHAMP 94/95
< 100 mg/dl 6% 58%
100-130 mg/dl 15% 16%
130-160 mg/dl 18% 4%
> 160 mg/dl 14% 0%
Not Documented 48% 22%
Results: Adherence to NCEP Treatment GoalsResults: Adherence to NCEP Treatment Goalsin Patients One Year Post Myocardial Infarctionin Patients One Year Post Myocardial Infarction
Fonarow Am J Cardiol 2001;87:819-822
EventPre-CHAMP 92/93
(n=256)Post-CHAMP 94/95
(n=302)
Recurrent MI 20 (7.8%) 10 (3.1%)
CHF 12 (4.7%) 8 (2.6%)
Hospitalization 38 (14.8%) 23 (7.6%)
Sudden Death 3 (1.2%) 2 (0.6%)
Cardiac Mortality 13 (5.1%) 6 (2.0%)
Noncardiac Mortality 2 (0.8%) 2 (0.6%)
Total Mortality 18 (7.0%) 10 (3.3%)
Pre and Post CHAMP Clinical Event RatesPre and Post CHAMP Clinical Event Rates
Follow-up for one year after discharge after acute myocardial infarctionFonarow Am J Cardiol 2001;87:819-822
*
*
*
*
* P < 0.05
14.8
6.4
Pre-CHAMP Post-CHAMP02468
1012141618
Death or Recurrent MI %
RR 0.43p<0.01
256 AMI pts discharged in 92/93 pre-CHAMP compared to 302 pts in 94/95 post-CHAMPASA 78% vs 92%; Beta Blocker 12% vs 61%; ACEI 4% vs 56%; Statin 6% vs 86% Fonarow Am J Cardiol 2001;87;819-822
CHAMP ~ Impact on Clinical Outcomes in CHAMP ~ Impact on Clinical Outcomes in the First Year Post Hospital Dischargethe First Year Post Hospital Discharge
68
12
4 6
92
68
52
8891
72
64
8994
78
70
90
ASA Beta Blocker ACEI Statin0
20
40
60
80
100
92/93
94/95
96/97
98/99
77
NRMI Registry Discharge Medications at UCLA compared to 1437 NRMI Hospitals
28
41
59
NRMI
UCLA
98/99
CHAMP ~ Sustained Impact Over a 6 CHAMP ~ Sustained Impact Over a 6 Year PeriodYear Period
Comparison to National Rx Rates
The CHAMP Protocol was associated with a significant increase in treatment utilization at the time of hospital discharge of medications previously demonstrated to improve survival in patients with CAD.
Initiation of cholesterol lowering medications prior to hospital discharge is safe, results in a high rate of utilization during longer term follow-up, and results in a significant increase in patients reaching LDL < 100 mg/dl.
CAD risk factor modification and treatment can be systematically integrated into the treatment received during cardiac hospitalizations without additional resources or medical personnel and is considerably more effective than conventional guidelines and care.
"Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP" Fonarow Circulation 1997;96(8):I-67
Implementation of a Cardiovascular Hospitalization Implementation of a Cardiovascular Hospitalization Atherosclerosis Management Program: CHAMPAtherosclerosis Management Program: CHAMP
19,599 men and women < 80 yo discharged post AMI, 58 Swedish Hospitals, 1995-19985528 (28%) statin rx vs 14071 (72%) no statin rx, highest hospital rates of use 48%; lowest 12% Stenestrand JAMA 2001;285;430-436
Early Statin Treatment Early Statin Treatment and Survival in AMIand Survival in AMI
0 100 200 300 400
Postadmission Days
0
1
2
3
4
5
6Mortality by Statin Treatment %
No Statin
Statin
RR 0.75 (0.63-0.89)
P=0.001
25% Risk Reduction
In-Hospital Lipid Lowering TherapyIn-Hospital Lipid Lowering Therapyis Associated with Markedly Lower Mortalityis Associated with Markedly Lower Mortality
10,288 patients with ACS OPUS-TIMI 163883 (38%) statin rx in hospital vs 6405 (62%) no statin rxCannon JACC 2001;35:334A
10.0%
90.0%
No Lipid Rx Lipid Rx
10 Month Compliance Rate
0 100 200 300 400
Postadmission Days
0
1
2
3
4
5
6Mortality by Statin Treatment %
No Lipid Rx
In-Hospital Lipid Rx
P<0.0001
42% RiskReduction
"Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP" Fonarow Circulation 1997;96(8):I-67
Cardiovascular Hospitalization Atherosclerosis Management Program
Clinical ImplicationsClinical Implications
At present, a large number of patients with coronary artery and other atherosclerotic vascular disease are not receiving treatments that have been demonstrated to reduce recurrent cardiovascular events and mortality.
Widespread application of hospital based treatment programs such as GWTG could dramatically effect CVD treatment rates with proven cost-effective therapies and thus substantially reduce the risk of future coronary events and prolong life in the large number of patients hospitalized each year with CVD.
Problem: Problem: Large CVD treatment gap Large CVD treatment gap and poor patient compliance with and poor patient compliance with conventional managementconventional management
Solution: Solution: In-hospital initiation of In-hospital initiation of therapy with excellent treatment rates therapy with excellent treatment rates and long term patient complianceand long term patient compliance
Simple, Rapid, and Most Importantly EffectiveSimple, Rapid, and Most Importantly Effective
Sidney Smith MDAHA Chief Science Officer
“The CHAMP study shows that the key to keeping heart disease patients alive is providing them with immediate and thorough treatment before they walk out of the hospital”
“This study provides the scientific foundation for programs similar to CHAMP such as the AHA’s new hospital-based quality improvement program called Get With The Guidelines”
What’s Involved in Starting a Hospital What’s Involved in Starting a Hospital Based Treatment ProgramBased Treatment Program
Collect baseline data or use existing data source– i.e. NRMI IV or collect data with discharge nurse, medical student, etc.i.e. NRMI IV or collect data with discharge nurse, medical student, etc.
Appoint team to develop treatment algorithm, preprinted orders, discharge forms
Present at lectures and staff in-services– present resultspresent results
– review successes and failuresreview successes and failures
– lead discussion regarding recommendations on protocol improvement lead discussion regarding recommendations on protocol improvement
Revise Protocol to close Gaps Communicate Revisions to Key departments Repeat cycle every quarter = CQI
Assess CHD Treatment Rates
Evaluate Assessment
Refine Protocol
Implement Refined Protocol
Continuous Quality Improvement Continuous Quality Improvement (CQI) Process(CQI) Process
Continuous Quality Improvement Continuous Quality Improvement (CQI) Process(CQI) Process
Mobilize GWTG Initiative•Establish “Buy In”•Identify “Champions”•Build Team
Plan & Prep Program•Attend CME Program•Develop Hospital Plan•Assign Roles & Responsibilities
Implement Program•Establish D/C Protocol•Collect Baseline Data•Obtain consensus
Monitor & Support•Collect & Report f/u Data•Review & Improve Process
Hospital BasedHospital BasedContinuous Quality Improvement (CQI) ProcessContinuous Quality Improvement (CQI) Process
Hospital BasedHospital BasedContinuous Quality Improvement (CQI) ProcessContinuous Quality Improvement (CQI) Process
What is the AHA“Get With What is the AHA“Get With the Guidelines” Program ?the Guidelines” Program ?
What is the AHA“Get With What is the AHA“Get With the Guidelines” Program ?the Guidelines” Program ?
Implemented by AHA Affiliates/Volunteers who will mobilize advocacy networks at the Affiliate level to:
Implement CME-driven educational programs Provide workshops for dissemination of guidelines Develop care maps Formalize a national discharge protocol Implement discharge protocols in hospital setting Identify best practices for AHA recognition awards Develop and disseminate reports and publications Measure changes and report outcomes data Drive impact into communities
GWTG Tools and ResourcesGWTG Tools and Resources
AHA/ACC Guidelines AHA National Discharge Protocol/Discharge Form Template Care maps - ED, cath lab, etc. CME programs AHA National teleconferences Public Service Announcements National and regional advocates
www.med.ucla.edu/champ
www.americanheart.org
Secondary Prevention: Secondary Prevention: Making it a RealityMaking it a Reality
A major CHD treatment gap still exists
The hospital is the ideal capture point, provides a teachable moment, and predicts care in the community
Programs like CHAMP improve treatment rates and saves lives, making it essential that each hospital implement a prospective process to help improve CHD patient care immediately
Measure and report treatment rates to ensure CHD patient care is optimal
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