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Background

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

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Background

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  1. 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

  2. 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).

  3. 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.

  4. 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.

  5. 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 measures-patients receiving all of the evidence-based treatments for which they were eligible, -“opportunity-based” overall composite score-

  6. 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.

  7. Limitations • This study was not a randomized clinical trial, and the improvements in performance measures may have been influenced by factors other than GWTG-CAD 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.

  8. 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.

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