Transcript Regional Differences in Quality of Care and Outcomes for the Treatment of Acute Coronary Syndromes: An Analysis from the Get With The.

Regional Differences in Quality of Care and Outcomes for
the Treatment of Acute Coronary Syndromes: An
Analysis from the Get With The Guidelines Program
Warren Laskey, MD; Nathan Spence; Xin Zhao, MS, BA; Rebecca Mayo,
RN, PhD, MA, CNP; Eric Peterson, MD, MPH; Adrian F. Hernandez, MD;
Christopher P. Cannon,Gregg C. Fonarow, MD
Background
Significant
opportunities
for
improvement
in
adherence
to
evidence-based guidelines exist. It
has been described that many
geographic differences in the delivery
of evidence-based guided care
following an AMI also exists. Similarly,
guideline adherence may improve the
quality of care for patients with acute
coronary syndromes (ACS).
Introduction
Despite widely available evidence-based therapies that
have been shown to improve clinical outcomes for patients
with ACS, geographic disparities in the delivery and quality
of care exists.
GWTG-CAD quality improvement program may help to
improve quality outcomes and the delivery of care for
patients with ACS.
Objective
The purpose of this study was
to
evaluate
whether
participation in GWTG-CAD
could improve the regional
variation in quality of care and
in-hospital outcomes for ACS.
Methods
• Data was collected on 161,236 patients
hospitalized at centers participating in GWTG–CAD
program across 4 geographic regions from 2000 to
2008.
• Six measures were evaluated:
-aspirin within 24 hours
-aspirin at discharge
-lipid-lowering medication for qualified patients
-smoking cessation advice
- “all or none” process performance measurespatients receiving all of the evidence-based
treatments for which they were eligible,
-“opportunity-based” overall composite score-
Results
• There was no significant regional variation in
either the “all or none” (Northeast:79.3%;
Midwest: 83.2%; South: 78.9%; West: 81.9%) or
“opportunity-based”(Northeast:91.9%;
Midwest: 93.6%; South: 91.5%; West: 92.6%)
composite performance measures.
• Both
performance
measures
exhibited
significant improvement with participation time
irrespective of region.
• In-hospital mortality was similar among
regions.
Adjusted hospital LOS was
significantly shorter in the Midwest.
Limitations
• This study was not a randomized clinical
trial, and the improvements in performance
measures may have been
influenced by factors other than GWTGCAD participation such as secular trends.
• Data were collected by medical chart
review and depend on the accuracy and
completeness of documentation.
• Participation in GWTG is voluntary and may
select for higher performing hospitals.
Conclusion
Hospitals participating in the GWTG-CAD
quality improvement program provide a
high level of guideline-based performance
over disparate geographic regions. Results
may provide further impetus for hospitals to
participate in a quality improvement
program such as GWTG-CAD or develop
internal systems to achieve greater
compliance with the current guidelines.