Prospective intervention process in the hospital setting, designed to significantly increase CHD and Stroke discharge treatment rates.
1. Supports system improvements for CHD and Stroke patients
2. Encourages links between cardiologist/
neurologists and primary care physicians
3. Provides resources to build consensus and establish and execute protocols
Implement discharge protocols in hospital setting
Implemented by AHA Staff/Volunteers who will mobilize networks at the Local level
Implement CME-driven educational programs
Identify best practices for AHA recognition awards
Develop and disseminate reports and publications
Measure changes and report outcomes data
Drive impact into communities
What is Get With The Guidelines ?
Best Practice - Pilot 1999 - New England Affiliate of the AHA launches “Get With the Guidelines” Pilot 1996 - QAP participant 1997 - Nurse based lipid clinic 1998 - QI initiative at Memorial Hospital American Journal of Cardiology - February 10, 2000
Get With The Guidelines - Pilot
AHA New England Affiliate - Merck, PRO Partnership
85 of the regions’ 160 acute care hospitals currently participating
All three of the PRO’s using the process for 6th scope of work implementation of AMI, CHF, Atrial Fibrillation indicators
Assess CHD Treatment Rates Analyze Discharge Rates Evaluate Assessment GWTG Team Reviews Summary Reports Refine Protocol GWTG Team Identifies Areas for Improvement Implement Refined Protocol GWTG Team Coordinates Implementation of Refined Protocol Find & Support a Champion
What are Hospital Teams Agreeing to do?
Identify/create the hospital implementation team
Attend a Get With The Guidelines Meeting
Agree to implement the AHA discharge protocol
Measure baseline performance level
Assess level of consensus within the hospital
What are Hospital Teams Agreeing to do?
F/u recovery plan for non-participating and lagging hospitals
Routine follow-up with all participants to get new data & assess progress every 3-months
Best practice sites for advocates and preceptorships
Receive recognition -- add to “Buzz”
Find an opportunity to improve
An opportunity exists to improve use of evidence based treatment guidelines for CAD prior to hospital discharge.
Organize a team
A team was organized with representatives from Cardiology, Internal Medicine, Emergency Medicine, Family Medicine, Case Management, Nursing, Rehab Services, Pharmacy, Performance Improvement, Product Line Development, Information Services.
Clarify the knowledge of the process
There is a shift from interventional treatment to a diagnostic and therapeutic focus, addressing underlying atherosclerotic disease. Patients should be treated with therapies that alter the natural history of atherosclerosis, decrease cardiac events, and improve survival. Regardless of treatment, every patient should be treated for smoking cessation, exercise and weight management, BP control, lipid and diabetes management, antiplatelet agents, ACE inhibitors, and beta blockers. Patients placed on treatment protocols in the hospital have better long term compliance and lower costs per discharge.
Understand the causes of variation
Despite compelling scientific evidence and national treatment guidelines supporting the use of secondary prevention medical therapies, therapies (smoking cessation, weight management, patient education in sodium restricted Step II AHA diet and exercise, rehab services, Ace Inhibitors and lipid lowering agents) continue to be underutilized at UCIMC. The AHA’s Get With the Guidelines program provides a framework for change.
Select the process improvement
The team selected improvements in:
ED algorithm and admitting order sets
Focused lectures and discharge process
Patient Education and prospective clinical measure benchmarking
Plan the improvement
Measure baseline then ongoing results
Communicate program with benchmark data
Identify champions and organize team
Educate providers and staff
Implement guidelines and develop algorthms and order sets