Author:
Stommel Manfred,Olomu Ade,Holmes-Rovner Margaret,Corser William,Gardiner Joseph C
Abstract
Abstract
Background
Adherence to clinical practice guidelines for the treatment of specific illnesses may result in unexpected outcomes, given that multiple therapies must often be given to patients with diverse medical conditions. Yet, few studies have presented empirical evidence that quality improvement (QI) programs both change practice by improving adherence to guidelines and improve patient outcomes under the conditions of actual practice. Thus, we focus on patient survival, following hospitalization for acute coronary syndrome in three successive patient cohorts from the same community hospitals, with a quality improvement intervention occurring between cohorts two and three.
Methods
This study is a comparison of three historical cohorts of Acute Coronary Syndrome (ACS) patients in the same five community hospitals in 1994–5, 1997, 2002–3. A quality improvement project, the Guidelines Applied to Practice (GAP), was implemented in these hospitals in 2001.
Study participants were recruited from community hospitals located in two Michigan communities during three separate time periods. The cohorts comprise (1) patients enrolled between December 1993 and April 1995 (N = 814), (2) patients enrolled between February 1997 and September 1997 (N = 452), and (3) patients enrolled between January 14, 2002 and April 13, 2003 (N = 710).
Mortality data were obtained from Michigan's Bureau of Vital Statistics for all three patient cohorts. Predictor variables, obtained from medical record reviews, included demographic information, indicators of disease severity (ejection fraction), co-morbid conditions, hospital treatment information concerning most invasive procedures and the use of ace-inhibitors, beta-blockers and aspirin in the hospital and as discharge recommendations.
Results
Adjusted in-hospital mortality showed a marked improvement with a HR = 0.16 (p < 0.001) comparing 2003 patients in the same hospitals to those 10 years earlier. Large gains in the in-hospital mortality were maintained based on 1-year mortality rates after hospital discharge.
Conclusion
Changes in practice patterns that follow recommended guidelines can significantly improve care for ACS patients. In-hospital mortality gains were maintained in the year following discharge.
Publisher
Springer Science and Business Media LLC
Reference39 articles.
1. Mehta RH, Montoye CK, Gallogly BA, Baker P, Blount A, Faul J, Roychoudhury C, Borzak S, Fox S, Franklin M, Freundl M, Kline-Rogers E, LaLonde T, Orza M, Parrish R, Satwicz M, Smith MJ, Sobotka P, Winston S, Riba AA, Eagle KA: Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA. 2002, 287: 1269-76. 10.1001/jama.287.10.1269.
2. Eagle KA, Gallogly M, Mehta RH, Baker PL, Blount A, Freundl M, Orza MJ, Parrish R, Riba AL, Montoye CK: Taking the National Guideline for Care of Acute Myocardial Infarction to the Bedside. Jt Comm J Qual Improv. 2002, 28: 5-19.
3. Eagle KA, Kline-Rogers E, Goodman SG, Gurfinkel EP, Azevum A, Flather MD, Granger CB, Erickson S, White K, Steg PG: Adherence to evidence-based therapies after discharge for acute coronary syndromes: An ongoing prospective, observational study. Am J Med. 2004, 117: 73-81. 10.1016/j.amjmed.2003.12.041.
4. Watson RE, Stein AD, Dwamena FC, Kroll J, Mitra R, McIntosh BA, Vasilenko P, Holmes-Rovner MM, Chen Q, Kupersmith J: Do race and gender influence the use of invasive procedures?. J Gen Intern Med. 2001, 16: 227-34. 10.1046/j.1525-1497.2001.016004227.x.
5. Barber K, Stommel M, Kroll J, Holmes-Rovner MM, McIntosh BA: Cardiac rehabilitation for community-based patients with myocardial infarction: Factors predicting discharge recommendation and participation. J Clin Epi. 2001, 54: 1025-30. 10.1016/S0895-4356(01)00375-4.
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