Transcript Get With The Guidelines

Get With The Guidelines
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Saving Lives…One Hospital, One Patient at a Time
September 28, 2006
Present by:
Mary Paulsen, MSN RN
Quality Improvement Director
American Heart Association/American Stroke Association
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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• Benefit of Get With The Guidelines
• Collaborative opportunities underway with DOH/CMS/GWTG
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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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Heart Disease and Stroke Today
More than 70 million Americans have one or more types of cardiovascular
disease…AHA and ASA, along with our strategic alliance partners and
donors, work every day to lessen the human and financial toll of these
chronic diseases.
Cardiovascular diseases (CVD) accounted for 38% of deaths in the U.S. in 2002
32% of these deaths from CVD occurred prematurely
Heart attack survivors have 1.5-15 times greater risk of illness/death post-event
In 2005, the estimated direct and indirect cost of CVD is $393.5 billion
*American Heart Association, Statistical Update, 2005
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Heart and Stroke Patient Treatment
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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Peace of Mind for Patients and
their Loved Ones
Higher Quality of Care
Consistent, comprehensive, proven treatment methods
Customized Education Information
Short and long-term prevention strategies are based on patient’s specific risk profile
Improved Communication With Healthcare Providers
Increased coordination between hospital and referring physicians
Up-to-date Prevention Strategies
New techniques are made available through easy-to-understand tools
Decreased risk of death or recurrent related health problems
“Patients have a 10-to-15 fold higher likelihood of adhering
to recommended prevention therapy when it is started in the hospital.”
*Physicians’ Weekly, June 21, 2004
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Proof Points
Hospitals have shown “across the board improvement” in quality of care
provided to patients through the Get With The Guidelines initiative.
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- Kenneth A. LaBresh, Brown University
• > 1000 hospitals currently participate in the program, improving the care of
660,000 patients
• Since its inception in 2001, Get With The Guidelines has grown to three modules
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• Several studies among Get With The Guidelines hospitals across the country have
shown:
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– Adherence to all ten measures were enhanced in year one for GWTG-CAD
– Racial and ethnic treatment disparities were narrowed or eliminated in 83% of
measures
– Gender-related treatment gaps were narrowed or eliminated in four of five measures
– An average of 20% improvement in eight measures for GWTG-Stroke in one year
*The Wall Street Journal, November 9, 2003, Abstracts from AHA’s Scientific Sessions, 2004, Abstracts from ASA’s International Stroke Conference 2005
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Collaborative Opportunities Underway
• New Mexico Department of Health funding ~funding for 5 GWTG
Stroke modules placed by July 06
• Funding from State Legislature
• Colorado State Stroke Registry ~ funding for 26 hospitals to
participate in GWTG Stroke by July 07
• Amendment 35 Funding
• Colorado Foundation for Medical Care “Get With the Guidelines”
Grant – funding for 34 modules (CAD and/or HF) to be placed by
July 07
• Amendment 35 Funding
Our Future Plans
With your generous and much needed support in the coming years,
we will continue to work toward attaining our lofty objectives:
 Position AHA/ASA guidelines as the preferred standard of care
 Increase implementation to 1,800 hospitals across the country by the end of 2008
 Obtain 85% compliance by hospitals on the Get With The Guidelines indicators
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 Leverage research to further enhance quality of care by gathering current best
practices
 Champion the issue of health information technology and integrate hospital
electronic systems
 Explore potential to create new custom modules for more deadly, debilitating
disease states
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Appendix
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Research Review
Studies and Reports
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“Crossing the Quality Chasm: A New Health System for the 21st Century” Institute of Medicine, March 2001
“To Err is Human” Institute of Medicine, 1999
“Cardiac Program Unites Staff at Denver Hospital,” Sidebar – Presbyterian/St. Luke’s Success, Mary Jensen,
RN, Kind Hearts and Helping Hands
Articles
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“In-Hospital Initiation of Guideline-Recommended Therapies and Patient Education Improves Treatment Rates,
Long-Term Adherence, and Clinical Outcomes” Physician’s Weekly, June 21, 2004
“Heart Patients More Likely to Live When Recommended Medicines Used in Combination” Circulation:
Journal of the American Heart Association, February 17, 2004
“More Kentucky Hospitals Following Heart Disease Prevention Program Guidelines” Kentucky Department of
Health, January 2004
December 2003 Media Coverage Summary of Get With The Guidelines
November 2003 Media Coverage Summary of Get With The Guidelines
“Heart Studies Cite Treatment Gaps” Wall Street Journal, November 9, 2003
Cardiovascular Watch Newsletter, May 21, 2004
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Research Review
Press Releases
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“American Heart Association's Hospital-based Quality Improvement Program Receives Award From Health and
Human Service Secretary Tommy Thompson” American Heart Association, December 13, 2004
“Hospitals That Follow Heart Attack Guidelines Have Lower In-Hospital Death Rates” American Heart
Association, November 17, 2002
“Hospitals That Follow Guidelines May Reap Rewards” American Heart Association, October 13, 2002
“American Heart Association Encourages Acute Care Hospitals to Get With The Guidelines ” American Heart
Association, August 2002
“American Heart Association Healthcare Quality Improvement Program Recognized by U.S. Health and Human
Services” American Heart Association, February 28, 2002
“Heart Treatment Gap Closes With Standardized Care” American Heart Association, October 2001
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