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Transcript Department of Transportation
Addressing Systems Change for Heart
Disease and Stroke Prevention through
GWTG-Patient Management Tool
Presentation to:
Council of State Governments Health Policy Forum
On Cardiovascular Health and Wellness
September 28, 2006
Brian Boisseau
Program Manager
Heart Disease and Stroke Prevention Program
Kentucky Department for Public Health
“Houston…we have a problem”
• Kentucky has higher than national averages
in heart disease and stroke.
• Kentucky has higher rates of hypertension in
whites and blacks than rest of the nation.
• Kentucky has the highest smoking rate in the
nation.
• Kentucky average for cholesterol higher than
nation.
• No statewide network for system change.
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“Houston…we have a problem”
• Health care costs increasing due to risk
factors of heart disease and stroke.
• Health care not always provided equally.
• How do we get to the 2010 goals if we keep
doing the same things the same way?
• “If you always do what you always did, you’ll
always get what you always got!”
• See the need, do the deed!
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CDC—Mission Control
Promote policy and system change to assure
quality care through adherence to primary
and secondary prevention guidelines.
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CDC—Mission Control
• Hospitals
– Implement American Heart Association’s Get
With the Guidelines for coronary artery disease
and stroke quality improvement; or Guidelines
Applied in Practice (American College of
Cardiology) to support implementation of
ACC/AHA cardiovascular guidelines.
• Chief partners are state QIO and AHA.
• Similar strategies as listed in primary care.
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MISSION OUTCOMES
• Increase the number of people who have high
blood pressure under control
• Increase the number of people with total
blood cholesterol less than 200 mg/dL
• Increase the number of people who know the
signs and symptoms of heart attack and
stroke, the risk factors for heart disease and
stroke, and the importance of calling 9-1-1
• Improve Emergency Response
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MISSION OUTCOMES
• Improve Quality of Care
• Eliminate Disparities in terms of race,
ethnicity, gender, geography, or
socioeconomic status
• Decrease mortality
• Decrease health care costs
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WHAT WAS THE MISSION?
• Implement Get With the Guidelines in 26
Kentucky Hospitals by the end of FY 2003.
• Evidence based guidelines developed by
AHA and ACC.
• Provides guidelines based care to all
patients, equaling the field for patients
regardless of geography, race,
socioeconomic status…eliminates disparities.
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“One Small Step for Man….”
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WHAT IS GWTG?
What is Get With The GuidelinesSM?
• The premier hospital-based quality
improvement program for the American
Heart Association
• Leverages the “teachable moment”
immediately after a patient has had an
acute event
• Tools that allow healthcare providers to
concurrently assess treatment
compliance
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WHAT IS GWTG?
What is Get With The GuidelinesSM?
• Provides a framework for Continuous
Quality Improvement
• Winner of the 2004 Health and Human
Services, Innovation in Prevention
Award
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WHAT IS GWTG?
A prospective intervention process in
the hospital setting, for coronary artery
disease, heart failure, and stroke
patients, designed to significantly
increase compliance with secondary
prevention treatment rates by the time
of discharge
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WHAT DOES GWTG DO?
Supports system improvements for
coronary artery disease, heart failure,
and stroke patients
Encourages links between
cardiologists, neurologists,
intensivists, primary care physicians,
and ancillary healthcare providers
Provides resources to build consensus
and establish and execute protocols
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WHAT DOES GWTG DO?
Get With The Guidelines offers
hospitals a Recognition Program
which encourages hospitals to
excel by achieving 85% compliance
in the indicators for each module.
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WHAT DOES GWTG DO?
Get With The Guidelines offers
hospitals three (3) Performance
Achievement Awards recognizing
hospitals that maintain a
consistent, high level of quality
within the GWTG program.
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WHAT ARE THE MODULES?
•GWTG-Coronary Artery Disease
(KY 2003)
•GWTG-Stroke (KY 2005)
•GWTG-Heart Failure (KY 2006)
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What are the CAD performance
measures that need 85% adherence
for recognition?
•
•
•
•
•
•
Smoking Cessation counseling for current
smokers or persons who have smoked within the
last twelve (12) months
Aspirin on Discharge*
Beta-blocker on Discharge*
ACE-I on Discharge*
Lipid lowering therapy on Discharge*
*In eligible patients without contraindications
(designated by CMS as “Ideal Patients”)
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What are the Stroke performance
measures that need 85% adherence
for recognition?
1. Percent of acute ischemic stroke patients who
arrive at the ED at hospital within 120 mins of
onset of stroke symptoms who receive IV t-PA
within 180 mins of onset of stroke symptoms.
2. Percent of ischemic stroke or TIA patients who
receive antithrombotic medication within 48 hours
of hospitalization.
3. Percent of ischemic stroke or TIA patients
discharged on antithrombotics.
4. Percent of ischemic stroke or TIA patients with
atrial fibrillation who are discharged on
anticoagulation therapy.
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Continued
What are the Stroke performance
measures that need 85% adherence
for recognition?
5.
6.
7.
Percent of patients at risk for DVT who received
DVT prophylaxis by the 2nd hospital day.
Percent of ischemic stroke or TIA patients with
LDL>100 mg/dL OR on cholesterol reducer prior
to admission who are discharged on cholesterol
reducing drugs.
Percent of smokers who receive smoking
cessation advice or medication.
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What are the Heart Failure
performance measures that need 85%
adherence for recognition?
1. HF Discharge instructions provided to all eligible
patients
2. Measurement of LV function in all eligible patients
3. ACE inhibitor and/or ARB at discharge provided
to eligible patients with LVEF < or = 0.40.
4. Beta blocker at discharge provided to eligible
patients.
5. Smoking cessation counseling provided to all
eligible patients (current or recent smokers)
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What Did We Do?
• Trained hospitals at statewide workshop with
partners.
• AHA provided training/education and we
helped support the education materials and
facilities for training.
• KY CVH program served as facilitators.
• Program was successful.
• 26 Hospitals contracted to do GWTG.
• Follow-up GWTG Quality Improvement
Workshop in January 2004
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Who Was Involved
• American Heart Association
• Kentucky Hospital Association
• Health Care Excel (Kentucky Medicare
QIO)
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What Happened After?
• Through the continuance of implementing
GWTG w/ Stroke module, formed partnership
with the University of Louisville Stroke Team.
• Partnership developed into contract for
services.
• U of L provided provider education, nursing
symposium, EMS education, and community
education in Louisville DMA, to affect the
stroke systems of care.
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What Happened After?
• Heart Disease and Stroke Program Manager
invited to speak to Get Healthy Kentucky
Board about state of stroke in Kentucky.
• Manager invited Dr. Remmel to attend and
present as well.
• AHA presented on their efforts.
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What Happened After?
• Dr. Remmel made impression on board.
• Change was sought at licensure level for
hospitals who claim to be Stroke Centers to
be JCAHO Stroke Center Certified.
• Not successful in licensure change.
• Dr. Remmel invited to speak to legislature by
AHA.
• Resolution adopted by senate to “Urge the
development of stroke systems of care.”
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GWTG Module Data - Hospitals
Module
Total
GWTG
Hospitals
OVA
GWTG
Hospitals
KY
GWTG
Hospitals
Total Patients
Enrolled
CAD
592
50
17
340,365
HF
319
22
9
72,737
STROKE
813
63
22
250,256
1724
114
48
485,839
TOTAL
Data Current as of August 31, 2006
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GWTG Module Data - Patients Enrolled
Module
CAD
Patients
Enrolled
Nationally
Patient
Enrolled in
OVA
Patients
Enrolled in KY
340,365
15,334
4,332
73,475
4,279
593
STROKE
252,227
25,129
4,286
TOTAL
485,839
44,732
9,211
HF
Data Current as of August 31, 2006
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RECOGNITION PROGRAM
Module
CAD
HF
STROKE
TOTAL
National
Performance
Achievement Awards
85
Ohio
Valley
PAA’s
6
21
60
166
4
6
16
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Kentucky
PAA’s
2
0
1
3
CONTACT INFORMATION
Brian Boisseau, Program Manager
Heart Disease and Stroke Prevention Program
Kentucky Department for Public Health
275 E Main St, HS2W-E
Frankfort, KY 40621
Tel: 502-564-7996 ext. 3823
Fax: 502-564-4667
Email: [email protected]
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