© American Heart Association 2001 Get With The Guidelines ...


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  • Presenter: Put your information on this slide.
  • The American Heart Association actually began the Get With The Guidelines initiative about two years ago, in a pilot effort with the New England Affiliate. This program is a process in which we can close the gap from what we know in secondary prevention, and what we do when we take care of our patients. Dr. Sid Smith, Chief Science Officer of the American Heart Association, spoke about the treatment gap in his Presidential Address during the American Heart Association’s 1995 Scientific Sessions. And at the November 2000 Scientific Sessions, American Heart Association president, Dr. Rose Marie Robertson not only restated that we have a treatment gap, but that we now have a solution to the gap: implementation of Get With The Guidelines .
  • The American Heart Association established an ambitious organizational goal to reduce coronary heart disease, stroke and risk by 25% by the year 2010. Two strategies that will address this goal are establishing systems to implement the American Heart Association’s primary and secondary prevention guidelines, and to increase the number of patients (with two or more risk factors) to have risk factors managed to established goals. Get With The Guidelines will help us accomplish this goal.
  • To put this into context, when we think about the healthcare continuum, people migrate within this continuum. The first category represents the healthy population, presumably that is most people. Some people have underlying vascular disease. They are undiagnosed, and have no clinical manifestations. Many have risk factors that are not treated. Some people go from having the sub-clinical disease into having the acute event. The acute event may be a heart attack, unstable angina; they may require by-pass surgery or angioplasty. When patients leave the hospital setting, the move into the post-event category.
  • What this initiative speaks to is using the hospital as the “capture point.” There about 5,000 acute care hospitals in the United States. There are about 177,000 physician practices. If we want to implement system-change that will impact the most patients, we must focus on the hospital setting. Further, if we consider that about 1,500 of those 5,000 hospitals account for 75% of CV discharges in the United States we can focus our efforts where we can make the greatest impact. Through digital strategies, this program can reach all audiences.
  • Let’s now talk about where we are today.
  • This slide represents the HCFA data reported in an October 2000 JAMA article. Data was collected on 750 patients per state, and although that is a modest sample, it was a very rigorous chart review. These patients came into the hospital with an AMI, and all of them were screened so that all of these interventions should have occurred in each of these patients. The right column indicates where we should be “optimally.” The left-column indicates where we are nationwide. As we consider the number of AMI’s annually, a 15% treatment gap for aspirin is far-reaching. Cholesterol was not measured in the HCFA survey, and the data comes from the National Registry for Myocardial Infarction. It represents about 100,000 patients and is from July 2000. At that time, it was reported that 37% of patients were leaving the hospital on a lipid-lowering intervention. We know that about 96% of patients leave the hospital with an elevated lipid level and would benefit from a cholesterol-lowering intervention. Again, a substantial gap in treatment.
  • This slide shows statistics for patients after they’ve had an event. (Speaker should relay the information.) Programs such as Get With The Guidelines can help change these statistics by getting these prudent therapies to our patients
  • Let’s take a look at some examples of what happens when such a program is implemented.
  • First we’ll take a look at the CHAMP study conducted by Dr. Gregg Fonarow at UCLA Medical Center.
  • The study began in 1992-93, before the guidelines were published (1995).
  • These represent the discharge rates based on initiating prudent thereapies in 1992-93. They initiated some very simple protocols that were designed to make a system that was reasonably error-proof. That is a system that is established for a patient coming into the hospitasl, there are standing orders and discharge protocols that make this process routine. You’ll notice significant improvement between 1993 and 1996. One number clearly stands out: administration of a lipid-lowering drug. And when we look at the 12-month follow-up data, the number is even higher. It is important to note that about 50% of patients will not continue to take their medicines one year after they’ve been prescribed, particularly for a medicine that does not make them “feel better.” But by starting the medicine in the hospital where the patient associates it with their event, it tells them that it is important.
  • This demonstrate pilot data from our sites. Note that as hospitals have entered the program during the first six months of the pilot this data is a mix of baseline or early intervention data as well as data from hospitals with somewhat more mature programs.
  • This demonstrate pilot data from our sites. Note that as hospitals have entered the program during the first six months of the pilot this data is a mix of baseline or early intervention data as well as data from hospitals with somewhat more mature programs.
  • Let’s explore the gap and how to bridge it.
  • This slide is taken from a presentation made by Dr. Gray Elrodt from Berkshire Medical Center in western Massachusetts. At Berkshire Medical Center, their goal is 100% implementation of the interventions. They view anything less than 100% as a “medical error,” and that patient’s treatment is discussed at mortality and morbidity rounds – just like any other medical mistake. In Massachusetts, the GWTG intervention team estimated that if the interventions were implemented with every patient, every time, they estimated that they would save 782 patients annually from death or another coronary event. We have all the evidence that demonstrates what will impact efficacy, and the development of guidelines. Effectiveness is where it really happens. There is a “big gulf” between the two as demonstrated in this slide – and how do we bridge the gap between efficacy and effectiveness. The alligators represent what can happen – and who, and what, are impacted if we don’t effectively implement the guidelines. Our patients are impacted; third party payors, HCFA and accreditation agencies like JCAHO will be looking at how hospitals improve quality of patient care. This is a process-change.
  • Let’s take a look at some studies that show why we need to implement Get With The Guidelines , and why this gap is happening. The L-Tap survey was done by Dr. Tom Pearson, in upstate New York, among primary care physicians looking at cholesterol treatment within their patient group. This study looked at those physicians considered “the best of the best” in the country. What they found is that only 18% of their patients with coronary disease are treated to goal. This is consistent with other information we are have that confirms we are not doing a very good job when it comes to implementing the guidelines. What’s very interesting, as demonstrated in the L-Tap survey, is that these physicians were aware of the guidelines 95% of the time. When asked if they implement them, they said they did it virtually all of the time. But when the patients’ charts were evaluated, it was found that only 18% of their CAD patients were treated to goal. This study is one of many that continues to confirm that it is not a “knowledge-based” problem, but a “process-based” problem. In medical school, we are taught the “what” – this is “what” we are supposed to do – not the “how” to do it. We need to address the “how.”
  • The NHANES study is a large, national survey that is done periodically. The survey showed that about 1/3 of patients should be on cholesterol-lowering therapy; and 65% of those patients are not receiving treatment.
  • Let’s take a look at the hospital-setting with this next slide. It represents results from 50 hospitals, 5,000 patients. Only one in four patients left the hospital on ACE-I and Beta Blockers. And as mentioned earlier with the National Registry of Myocardial Infarction data, about 1/3 of patients are discharged on cholesterol-lowering therapy. So we went from 25% to 37% over a three-year period. That’s encouraging – but we cannot continue to go at this pace. Our job is to accelerate that pace.
  • Let’s talk about why we are not implementing the guidelines which was mentioned briefly earlier.
  • We need to have consensus and agreement about the guidelines. (presenter should read through this slide and reference the study published in JAMA.) A good analogy is the process an airline pilot goes through before take-off and landing. They go through a “check list” to be sure they are not leaving anything to “chance” or memory. When we consider which is more complicated: the airplane or the human body? But where do we use a checklist? Do we want to go to a hospital where we don’t use a check list to be sure everything we do, those routine things that we know work, aren’t being used.
  • Patients can also be advocates for treatment. They are learning more about treatments and effects (through reading, the Internet, etc.) and they are asking questions about their treatment. They are becoming “partners” in their treatment. Environmental issues are becoming big issues for hospitals. Managed care health plans and the Health Care Finance Administration (HCFA) are developing value-based reimbursement systems. The Massachusetts Blue Cross health plan has a pilot program that will reward hospitals by paying them more in reimbursement if they perform better in these prevention processes. HCFA will reimburse hospitals at a higher level for by-pass patients who are discharged on specified secondary prevention therapies. That’s compelling and makes good business sense.
  • So how can we improve and implement these interventions. What’s the solution?
  • The American Heart Association is introducing Get With The Guidelines , a prospective intervention program for the hospital setting. The program supports system improvements that will try to create “error-proof” systems. Encourages links between the hospital physician and the primary care physician and the program offers resources to facilitate consensus and implementation.
  • The program is implemented through a mobilization of local networks: key program champions. By bringing together health care professionals, the state peer review organization, health care providers, department of health, and others, we can form a local network of program champions who join together to implement the program. We will identify better practice examples to share and learn from, and we’ll be able to track and measure program implementation. Hospitals should not compete, but share and learn and work together to improve patient care. It will drive positive impact in our communities.
  • The GWTG pilot was implemented by the American Heart Association’s New England Affiliate. It began with Dr. Kenneth LaBresh, in a cardiology practice in Rhode Island, who participated in a 1996 QAP study. He participated in the study, which looked at 500 charts, where he was happy to learn that his patients at goal were at twice the national average. He was very unhappy to learn that the national average was only 11%! As a long-time American Heart Association volunteer, and at the time, a national board member, he was appalled, but prepared to make the necessary changes. What he is quick to point out is that many physicians have the knowledge, and think they are doing a good job. But knowing the actual data, provides the critical knowledge that allowed him to make the necessary changes in his practice. He and his partners agreed to do a better job by creating a system change in their practice through the initiation of a nurse-based lipid clinic. They went from a practice-wide implementation of 15% to 60% in one year. He’s convinced they would still be in the 15-20% implementation range if they had not created the system. He and his partners had the knowledge, they did not have the system. They then translated the system to their hospital setting where they saw similar improvement. Dr. LaBresh then took the idea to the American Heart Association affiliate volunteers and built consensus to implement in the five state affiliate territory.
  • The program was a collaborative effort with peer review organizations, medical association, insurers and financial support from Merck & Co., Inc. More than 70 of the region’s 160 acute care hospitals are currently (January 2001) in the program.
  • The program success is based on the concept of “continuous quality improvement.” Identifying program champions is critical to move the program forward. Next, assessing our baseline treatment rates and communicating the data helps get buy-in. We evaluate and refine our protocols, implement the protocols and then reassess the data. This concept is based on rapid-cycle improvement. We do not have to have a “perfect” process in place to begin implementation. We continue to reassess and refine. We will see improvement almost immediately.
  • The program was a collaborative effort with peer review organizations, medical association, insurers and financial support from Merck & Co., Inc. More than 70 of the region’s 160 acute care hospitals are currently (January 2001) in the program. (There are two slides to this point)
  • The program was a collaborative effort with peer review organizations, medical association, insurers and financial support from Merck & Co., Inc. More than 70 of the region’s 160 acute care hospitals are currently (January 2001) in the program.
  • Why should we implement the program? Prevention is cost-effective. We will be rewarded with economic incentives as stated earlier. Accreditation agencies will require. Our patients will ask tough questions and demand this quality of care. Most importantly, as the studies show, it’s the right thing to do!
  • Brent James, MD from Intermountain Health points out that you manage what you measure. The process of continuous quality improvement requires the feedback of performance data to refine the process. The American heart association has created an internet -based data tool to help hospitals obtain the data they need.
  • Data obtained by retrospective chart review is often received by clinicians well after the care is given. This limits the opportunity to impact on current care. As data collection gets closer to care the loop of continuous quality improvement is shortened, allowing for “rapid cycle change.” When data can be obtained at the point of care with reminder systems the process can be further improved by providing feedback in real time for that patient when care can be impacted on every patient prior to discharge.
  • The American Heart association Data Tool is a point of service online tool designed to speed data entry, taking typically 90 seconds and 21 mouse clicks. Patient demographics including diagnosis, procedures done, and referring physician can be added from drop-down menus. The physician data, including fax number can be entered for each hospital and stored in the system. The system calculates BMI when height and weight are added.
  • Drop-down menus provide updated guideline information to prompt compliance with AHA recommended treatments and interventions. Because the software is housed centrally, new guideline data can be entered without the need for hospital IS personnel.
  • A note can be printed for patients to summarize prevention recommendations.
  • A summary note can be created by the system and automatically be faxed to the referring physician on discharge to provide for continuity of care.
  • The tool can be accessed with a palm pilot and used as care is given. Some hospitals have chosen to place a paper version of the tool on chart to collect data and enter at the time of discharge. Hospital performance can be accessed at any time and compared to AHA benchmarks and overall program performance. There is also the potential to use the tool to collect ORYX performance measures for the AMI and CHF core measure requirements.
  • This is an example of performance of four of our hospitals in the pilot program after 3 to 6 months of use. The columns represent from left to right, smoking cessation counseling, ACE inhibitor at discharge,beta-blocker at discharge, aspirin at discharge, measurement of LDL,blood pressure control at discharge, referral to cardiac rehabilitation, and lipid lowering medication at discharge. Notice that particular strengths in some measures such as smoking cessation counseling may be present in some of the hospitals but a weakness at others. By creating a forum in our face to face workshops or potentially on the web, hospitals are able to solutions in areas of strength and get help in areas in which they are challenged. We believe we can create a community of secondary prevention, dedicated to the concept that hospitals should not compete on such fundamentals of treatment as counseling for life style change and the use of medications to prevent subsequent cardiovascular events.
  • This demonstrate pilot data from our sites. Note that as hospitals have entered the program during the first six months of the pilot this data is a mix of baseline or early intervention data as well as data from hospitals with somewhat more mature programs.
  • It’s estimated that if this program is successfully implemented, we can join our colleagues in saving more than 40,000+ lives every year!
  • © American Heart Association 2001 Get With The Guidelines ...

    1. 1. © American Heart Association 2001
    2. 2. Get With The Guidelines-- Reaching our 2010 Impact Goal <ul><li>Overview of the Secondary Prevention Challenge </li></ul><ul><li>Get with the Guidelines Program Overview </li></ul><ul><li>The New England Affiliate Pilot and Results </li></ul><ul><li>National Roll-out </li></ul>
    3. 3. What would we like from you today? <ul><li>Understand and communicate objectives of this Bold Initiative </li></ul><ul><li>Identification of strategic partner contacts </li></ul><ul><li>Recruitment of key champions across the country </li></ul>
    4. 4. Ken LaBresh, M.D., FACC Associate Medical Director Mass PRO President, New England Affiliate
    5. 5. Get with the Guidelines- CVD and Stroke AHA / ASA’s Program for Saving Lives Through Effective Implementation of Secondary Prevention Guidelines
    6. 6. AHA GOALS <ul><li>By 2010, we will reduce </li></ul><ul><li>coronary heart disease, stroke and risk by 25% </li></ul>
    7. 7. The Healthcare Continuum Healthy Population Undiagnosed or Untreated In Treatment Acute Event Post Event
    8. 8. Implement Guidelines HERE Healthy Population Undiagnosed or Untreated In Treatment Acute Event Post Event
    9. 9. Status Report
    10. 10. AHA Guidelines <ul><li>Smoking Cessation </li></ul><ul><li>Lipid Management </li></ul><ul><li>Physical activity </li></ul><ul><li>Weight management </li></ul><ul><li>Asprin/other Antithrombotic agents </li></ul><ul><li>ACE inhibitors </li></ul><ul><li>Beta blockers </li></ul><ul><li>Blood pressure control </li></ul><ul><li>Diabetes Management </li></ul><ul><li>Stroke Specific: Atrial Fibrillation Management, Drug and Alcohol Abuse Management </li></ul>Adapted from Smith, Circulation 92:3, 1995
    11. 11. Implementation Statistics <ul><li>Indicator Rate Optimal </li></ul><ul><li>ASA 85%* 100% </li></ul><ul><li>Beta Blocker 72%* 100% </li></ul><ul><li>ACE-I 71%* 100% </li></ul><ul><li>Smoking Cessation 40%* 100% </li></ul><ul><li>Lipid Lowering 37%** 96% </li></ul><ul><li>*HCFA, 1998 **NRMI 2nd Q 2000 </li></ul>
    12. 12. Mortality Statistics <ul><li>Over 450,000 people suffer from recurrent coronary attacks each year. </li></ul><ul><li>Within 1 year of a recognized MI 25% of men and 38% of women will die </li></ul><ul><li>100,000 recurrent strokes occur each year </li></ul><ul><li>Within 1 year of a stroke 22% of men and 25% of women will die </li></ul><ul><li>14% of stroke survivors will experience a recurrent stroke within 1 year. </li></ul><ul><li>AHA 200 Heart and Stroke Statistical Update </li></ul>
    13. 13. Saving Lives: Real Results
    14. 14. CHAMP: C ardiac H ospitalization A therosclerosis M anagement P rogram
    15. 15. CHAMP: <ul><li>UCLA- Gregg Fonarow, MD </li></ul><ul><li>Hospitalizations are a captured patient encounter </li></ul><ul><li>Expedient one page algorithm for: </li></ul><ul><ul><li>ASA, Beta Blocker, ACE inhibitor, Lipid Rx, Aerobic Exercise, Dietary guidelines, Smoking cessation </li></ul></ul><ul><li>Lipid Goal: </li></ul><ul><ul><li>LDL < 100 mg/dl </li></ul></ul>
    16. 16. CHAMP : C ardiac H ospitalization A therosclerosis M anagement P rogram CAD Patient Treatment Rates* *Fonarow, G. et al. “Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP,” Abstract from the 70th Scientific Sessions, American Heart Association, November, 1997.
    17. 17. NRMI Registry Discharge Medications at UCLA compared to 1437 NRMI Hospitals Sustained Impact of CHAMP on Secondary Prevention Treatment Rates 77 59 41 28 NRMI Data 98/99
    18. 18. Improvement in Treatment Utilization is Associated With A Marked Reduction in Clinical Events RR0.43 p<0.01 256 AMI pts discharged in92/93 Pre-CHAMP- compared to 302 pts in 94/95 Post-CHAMP ASA 78% vs 92%; BetaBlocker12% vs 61%; ACEI 4% vs 56%; Statin 6%vs 86% Fonarow ,American Journal of Cardiology 2001(in press)
    19. 19. Bridging the Gap
    20. 20. <ul><li>Outcomes associated with an intervention under ideal circumstances </li></ul><ul><ul><li>Clinical trial reported in literature </li></ul></ul><ul><ul><li>Benchmarking </li></ul></ul>EFFICACY EFFECTIVENESS <ul><li>Outcomes associated with an intervention in the real world </li></ul><ul><ul><li>Hospital </li></ul></ul><ul><ul><li>Outpatient </li></ul></ul><ul><ul><li>Across Continuum </li></ul></ul>Bridging the Gap Between Efficacy and Effectiveness <ul><li>Systems to Translate Efficacy Effectiveness </li></ul>SYSTEMS
    21. 21. The Gap <ul><li>L-TAP survey showed </li></ul><ul><ul><li>95 % of PCPs are aware of NCEP guidelines </li></ul></ul><ul><ul><li>18 % of their CAD patients at goal </li></ul></ul><ul><ul><li>* Treatment Patterns and Distribution of Low-Density Lipoprotein Cholesterol Levels in Treatment-Eligible United States Adults, Hoerger et. al. American Journal of Cardiology 1998; 82: 61-65 </li></ul></ul>
    22. 22. The Gap <ul><li>NHANES III data* reveals </li></ul><ul><ul><li>28 % are eligible for treatment based on NCEP II </li></ul></ul><ul><ul><li>82 % of those with CHD are not at NCEP II goal for LDL </li></ul></ul><ul><ul><li>65 % of patients eligible for treatment are not receiving therapy </li></ul></ul><ul><ul><li>* Treatment Patterns and Distribution of Low-Density Lipoprotein Cholesterol Levels in Treatment-Eligible United States Adults, Hoerger et. al. American Journal of Cardiology 1998; 82: 61-65 </li></ul></ul>
    23. 23. The Gap <ul><li>QAP Data - Community based Cardiologists </li></ul><ul><ul><li>30-40 % Documented Treatment Rate </li></ul></ul><ul><ul><li>Treatment Gap of 61 % </li></ul></ul><ul><ul><li>Provider awareness does not result in successful implementation </li></ul></ul><ul><ul><li>* Treatment Patterns and Distribution of Low-Density Lipoprotein Cholesterol Levels in Treatment-Eligible United States Adults, Hoerger et. al. American Journal of Cardiology 1998; 82: 61-65 </li></ul></ul>
    24. 24. The Gap <ul><li>ACC Evaluation of Preventive Therapeutics (ACCEPT) Data </li></ul><ul><ul><li>20-25 % Documented Treatment Rate </li></ul></ul><ul><ul><li>Treatment Gap of 80 % </li></ul></ul><ul><ul><li>- Hospital data (N=50) 1996-97 </li></ul></ul><ul><li>NRMI 3 Data - 6/00 </li></ul><ul><ul><li>37 % of Post-MI patients discharged on a statin </li></ul></ul><ul><ul><li>(N = 101, 294) </li></ul></ul>
    25. 25. The Barriers
    26. 26. Physician Barriers <ul><li>Attitudes </li></ul><ul><ul><li>Agreement with specific guidelines </li></ul></ul><ul><ul><li>Agreement with guidelines in general </li></ul></ul><ul><ul><li>Outcome expectancy (performance of recommendations will not lead to desired outcome) </li></ul></ul><ul><ul><li>Self-efficacy (physician believes he cannot carry out recommendations) </li></ul></ul><ul><ul><li>Motivation (habits/routines) </li></ul></ul><ul><ul><li>From Cabana et al. JAMA. 1999; 282:1458-1465. </li></ul></ul>
    27. 27. Physician Barriers <ul><li>Behavior </li></ul><ul><ul><li>Patient factors (patient preferences vs. recommendations) </li></ul></ul><ul><ul><li>Guideline factors (complexity, conflicting recommendations) </li></ul></ul><ul><ul><li>Environmental Factors </li></ul></ul><ul><ul><ul><li>Lack of time resources </li></ul></ul></ul><ul><ul><ul><li>Financial disincentives </li></ul></ul></ul><ul><ul><ul><li>Organizational constraints </li></ul></ul></ul><ul><ul><ul><li>From Cabana et al. JAMA. 1999; 282:1458-1465. </li></ul></ul></ul>
    28. 28. The Solution
    29. 29. Get With The Guidelines <ul><li>Prospective intervention process in the hospital setting, designed to significantly increase CHD and Stroke discharge treatment rates. </li></ul><ul><li>1. Supports system improvements for CHD and Stroke patients </li></ul><ul><li>2. Encourages links between cardiologist/ </li></ul><ul><li>neurologists and primary care physicians </li></ul><ul><li>3. Provides resources to build consensus and establish and execute protocols </li></ul>
    30. 30. <ul><li>Implement discharge protocols in hospital setting </li></ul><ul><li>Implemented by AHA Staff/Volunteers who will mobilize networks at the Local level </li></ul><ul><li>Implement CME-driven educational programs </li></ul><ul><li>Identify best practices for AHA recognition awards </li></ul><ul><li>Develop and disseminate reports and publications </li></ul><ul><li>Measure changes and report outcomes data </li></ul><ul><li>Drive impact into communities </li></ul>What is Get With The Guidelines ?
    31. 31. 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
    32. 32. Get With The Guidelines - Pilot <ul><li>AHA New England Affiliate - Merck, PRO Partnership </li></ul><ul><li>85 of the regions’ 160 acute care hospitals currently participating </li></ul><ul><li>All three of the PRO’s using the process for 6th scope of work implementation of AMI, CHF, Atrial Fibrillation indicators </li></ul>
    33. 33. 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
    34. 34. What are Hospital Teams Agreeing to do? <ul><li>Identify/create the hospital implementation team </li></ul><ul><li>Attend a Get With The Guidelines Meeting </li></ul><ul><li>Agree to implement the AHA discharge protocol </li></ul><ul><li>Measure baseline performance level </li></ul><ul><li>Assess level of consensus within the hospital </li></ul>
    35. 35. What are Hospital Teams Agreeing to do? <ul><li>Implement program </li></ul><ul><li>F/u recovery plan for non-participating and lagging hospitals </li></ul><ul><li>Routine follow-up with all participants to get new data & assess progress every 3-months </li></ul><ul><li>Best practice sites for advocates and preceptorships </li></ul><ul><li>Receive recognition -- add to “Buzz” </li></ul>
    36. 36. Incentives for Change <ul><li>Prevention is Cost Effective Quality Care </li></ul><ul><ul><li>Risk Sharing and Capitation provide economic incentives </li></ul></ul><ul><ul><li>Our patients will demand it </li></ul></ul><ul><ul><li>Accreditation agencies will require it </li></ul></ul><ul><li>It’s the right thing to do ! </li></ul>
    37. 37. American Heart Association Data Tool
    38. 38. Information at the Point of Care IMPACT: Point of Care (where it can still improve clinical decision making) Near the Point of Care Distant from the Point of Care + ++ ++++
    39. 39. Demographics 6 clicks Clinical/Lab 8 clicks Discharge meds and interventions 7 clicks Interactively checks patient’s data with the AHA guidelines AHA TOOL: SIMPLE, ONE PAGE, ON-LINE FORM
    43. 43. How it’s being used: <ul><li>On-line completion at discharge on the floor </li></ul><ul><li>Paper form follows patient on front of chart and entered on-line at discharge. </li></ul><ul><li>Used as a QI tool with frequent reports to relevant departments, (also meet include AMI and CHF JCAHO core measure requirements). </li></ul>
    44. 44. Hospital Baseline Data Examples From the New England AHA Data Tool Pilot Hospital A Hospital B Hospital C Hospital D AHA Benchmarks Hospital Data
    45. 45. Percent of Patients Receiving Care Compared to AHA Goals in Quarter 4 NRMI comparison Measure
    46. 46. AHA Resources <ul><li>Large network of committed staff and volunteers with relationships in the community </li></ul><ul><li>Science - Guidelines development, data </li></ul><ul><li>Educational materials </li></ul><ul><li>Programs </li></ul><ul><ul><li>Get With the Guidelines </li></ul></ul><ul><ul><li>Operation Heart Beat </li></ul></ul><ul><ul><li>Operation Stroke </li></ul></ul><ul><ul><li>Call to Action </li></ul></ul><ul><ul><li>One of a Kind </li></ul></ul>
    47. 47. Join Us in Saving Lives! If Get With The Guidelines is implemented, more than 40,000+ lives could be saved every year!
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