Transcript Get With The Guidelines - Michigan Center for Rural Health

Get With The Guidelines
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Saving Lives…One Hospital, One Patient at a Time
presented to
The Michigan Center for Rural Health’s Quality Network
2-22-2008
by
Kimberly Sutter, MSN, RN, CNAA
Today’s Agenda
• Introduction to the American Heart Association
• The Critical Issue of Heart Disease and Stroke
• Challenges within Patient Care Today
• Get With The Guidelines Creates a Culture of Quality
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• Why Get With The Guidelines ?
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• How To Get Started
• Resources
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Our Story
Our organization was founded in 1924 by six
cardiologists who came together to share research
and promote further study of heart disease.
Since then, we’ve grown to be the largest voluntary
organization fighting heart disease/stroke in the
U.S. with 22.5 million donors and volunteers who
help direct more than $500 million each year to
our research for effective prevention and treatment
of CVD and stroke.
Together, we have made life longer and stronger.
Our work has funded the work of eight Nobel
Laureates and spurred revolutionary innovations
such as bypass surgery, CPR and the pace-maker…
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Together AHA and ASA
Organizational
Mission
Reduce disability and death from heart disease and stroke
Impact
Goal
Decrease heart disease, stroke and risk by 25% by 2010
Grassroots
Reach
Largest voluntary organization fighting heart disease/stroke in the U.S.
Groundbreaking
Research
- Fighting #1 and #3 killers of adults across all demographics and economic backgrounds
- Strategic driving force to provide credible, effective prevention/treatment information
- Strategy: To improve the quality of CVD outcomes for patients
- 12 affiliates and 2200 divisions across the country
- Professional membership of 13 scientific councils, three interdisciplinary working groups
- Trusted source for hospitals and healthcare providers across the country
Invest $400 million dollars in research, education and awareness annually
- Latest guidelines, journals, conferences, seminars and educational information provided
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A major Milestone was recently met!!
• American Heart Association Reaches
2010 Goal of Reducing Heart Disease-Ahead of Schedule! New mortality data
from the Centers for Disease Control and
Prevention (CDC) shows that, since 1999,
coronary heart disease and stroke ageadjusted death rates are down by 25.8
percent and 24.4 percent, respectively.
Imagine The Impact..Imagine The Difference..
In Our Patient’s Lives, and In Their Families Lives!
Let’s Make That Impact..
But, despite this milestone…Heart Disease and
Stroke are still the 1st and 3rd killers in Michigan and
in the US.
Our Work Isn’t Done..But, Now..We Know What Works!
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More than half of all heart disease and stroke patients
do not receive consistent preventive instructions
upon discharge from the hospital…
66% of heart failure patients
were discharged without four
proven prevention therapies
68% of patients who smoked
were not advised to quit
33% of “ideal” candidates were
not treated with ACE Inhibitors
*The Wall Street Journal, November 9, 2003, Physicians’ Weekly, June 21, 2004, ADHERE Study
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Challenging Reality
Proven, evidence-based preventive guidelines are known and available,
and should be part of every hospital’s routine…
…but sadly, this is not always the case.
“We now have a situation where medicine is by
memory. Busy clinicians try to recall for each
complex patient the appropriate evidence-based
therapies, all during the chaos of the day.
If they don't remember all of this…
there are repetitive oversights.”
Gregg Fonarow, MD, FACC, FACP UCLA Division of Cardiology
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Gaps in Overall Quality of Care
“Healthcare harms patients too frequently and routinely fails
to deliver its potential benefits. Between the healthcare that we now have
and
the healthcare that we could have lies not just a gap, but a chasm.”
Tens of thousands of patients die
each year due to preventable healthcare errors
More people die annually from medical errors than from
AIDS or breast cancer
It takes an average of 17 years
for new knowledge to be incorporated into practice
*Institute of Medicine, Shaping the Future for Health, 2001 and To Err is Human, 1999
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Devastating Results
“Patients go to hospitals, and half the time are being discharged without the
complete group of therapies that have been absolutely proven to prolong their life,
and there is no reason other than the medical system just isn’t working that well.”
40% of heart disease or stroke
patients will have a repeat event
38% of women and 25% of
men will die within a year of a
heart attack
25% of men and 22% of
women will die within a year
of a stroke
46% of women and 22% of
men will be disabled
*Physicians’ Weekly, American Heart Association Statistical Update
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Opportunity for Hope
Experts suggest that mortality rates after acute coronary syndromes could be
reduced by up to 80% just by properly instituting the knowledge and guidelines
already proven.
“There’s little disagreement on the value of making up these treatment gaps. We
need to break the gaps and recognize the tremendous barrier in outpatient care to
effectively implement and retain important therapies…to save more lives.”
Gregg Fonarow, MD
*Circulation, February 17, 2004, Physicians’ Weekly, June 21, 2004
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Introducing the Solution
The American Heart Association has developed an
unprecedented method to close this treatment gap
Derived directly from evidence-based guidelines, the program provides tools and
resources designed to help hospitals dramatically reduce patients’ risk
of recurrent cardiovascular events
“Get With The Guidelines is a model for the nation in addressing a dire
health-care issue.
The program helps patients, working with caregivers, learn how to take action to
save their own lives.” - Tommy Thompson, Secretary of HHS
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Proven Results
UCLA CHAMP Study
Scandinavian Simvastatin
Survival Study (4S)
Decrease in recurrent events/mortality:
34% risk reduction for recurrent events
42% risk reduction in CVD mortality
Decrease in recurrent events/mortality:
Risk down to 6.4% from 14.8%
Improvement in preventive treatments:
use of Statins up to 86% from 6%
use of Beta-Blockers up to 61% from 12%
use of ACE Inhibitors up to 56% from 4%
Brown University Study
Improvement in preventive treatments:
89% given aspirin, up from 75%
85% given Beta-Blockers, up from 62%
New England Pilot Program
Improvement in
preventative treatments:
86% smoking cessation,
up from 48%
88% lipid treatment,
up from 54%
74% rehabilitation referral,
up from 34%
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Program Strategy
1.
Incorporate latest proven research and knowledge of leading industry
groups
2.
Utilize “teachable moment” prior to patient discharge
3.
Take a multi-disciplinary team approach
4.
Develop and empower leaders to change culture of quality within hospitals
5.
Provide ability for measurement via Web-based clinical decision support
tool
6.
Provide hospitals with consistent patient-discharge protocols
7.
Offer customized patient materials
8.
Encourage provider-to-provider communications
9.
Recognize 85% compliant hospitals as performance leaders
10. Improve patient quality of life and reduce risk
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How It Works
The process-improvement and overall culture of change that is prompted by Get
With The Guidelines automatically drives increased patient safety
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Guidelines for Treatment and Prevention
Proven Risk Reduction Therapies:
- Lipid lowering therapy
- ACE Inhibitor/ARB use
- Beta-Blocker use
-Aspirin or other Antithrombotic medication
Adherence to these treatment
guidelines reduces risk of death
and/or recurrent events by up
to 40% in patients
-t-PA
Pre-discharge Counseling:
- Smoking cessation
- Weight and exercise management
- Insulin control
- Alcohol and drug abuse management
Post-treatment Referrals:
- Cardiac Rehabilitation
*American Heart Association
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AHA Support and Resources
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Hospitals Reap the Benefits
Easy
Implementation
Improved
Care
Improved
Outcomes
“With systems in place to get things done, I don’t have to
change one physician’s behavior at a time, but I give them a
system and framework in which to practice that’s quite easy to
implement.”
- Karol Watson, MD, UCLA Medical Center
“As a cardiologist…I’m convinced it is improving the care of
my patients. As an AHA volunteer, I’m equally convinced it’s
critical to improving the quality of care for patients
nationwide.”
- Robert O. Bonow, MD, 2002-2003 AHA President
“We did calculations based upon how well we were
performing before we initiated this program and
realized that we were going to be able to save lives or
prevent second heart attacks.”
- Gray Ellrodt, MD, Berkshire Medical Center
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Hospitals Reap the Benefits, cont’d
Increased
Communications
Cost
Savings
“What started as a program to help patients, helped our staff
too. Our collective brainstorming sessions gave us an
opportunity to be part of a creative, team experience toward a
positive goal.”
- Gregg Fonarow, MD, UCLA Cardiomyopathy Center
“We began to realize we were actually reducing the amount
of time documenting--by imbedding the guidelines into
order sets and discharge sheets, it decreased the amount of
time to write orders and on follow-up phone calls
regarding clarification of contraindications.”
- Mary Jensen, RN, Presbyterian/St. Luke’s Hospital
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