Closing the CHD Closing the CHD Treatment GAPTreatment GAP

Saving Lives Through Better ImplementationSaving Lives Through Better Implementationof Secondary Prevention Measuresof Secondary Prevention Measures

The Impact of Coronary Heart The Impact of Coronary Heart Disease in the United StatesDisease in the United States

14 million Americans alive today have a history of myocardial infarction, angina, or both.1

450,000 recurrent myocardial infarction occur each year, most of which could have been prevented

25% of men and 38% of women will die within 5 years of presenting with a AMI2

Studies suggest that a large number of CAD patients do not receive the therapies that can prevent recurrent events and save lives 3-5

1 AHA Heart and Stroke Facts: 1996 Statistical Supplement2 Rossouw, et al., N Engl J Med, 323:1112-1119.19903 Cohen, et al., Circulation, 83(4):1294-1304, 19914 Nieto, et al., Arch Intern Med, 155:677-684, 19955 Giles, et al., JAMA, 269 (9):1131-1138, 1993

AHA/ACC Guidelines to Risk Reduction AHA/ACC Guidelines to Risk Reduction For Patients With CHD and Other Vascular DiseaseFor Patients With CHD and Other Vascular Disease

Cessation of smokingCessation of smoking Lipid Management GoalsLipid Management Goals Primary Goal: LDL < 100 mg/dl Primary Goal: LDL < 100 mg/dl Secondary: HDL > 35 mg/dl TG < 200 mg/dl Secondary: HDL > 35 mg/dl TG < 200 mg/dl Physical activity: 30 minutes 3-4 times per weekPhysical activity: 30 minutes 3-4 times per week Weight managementWeight management Antiplatelet/anticoagulants:ASA 80 to 325 mg/day Antiplatelet/anticoagulants:ASA 80 to 325 mg/day (or warfarin)(or warfarin) ACE inhibitors (post-MI for LVD)ACE inhibitors (post-MI for LVD) Beta blockers for high-risk patients post-MI Beta blockers for high-risk patients post-MI Blood pressure control: goal Blood pressure control: goal << 140/90 mm Hg 140/90 mm Hg

Adapted from Smith, Circulation 1995;92:3Adapted from Smith, Circulation 1995;92:3

Comprehensive Medical Therapy For Patients Comprehensive Medical Therapy For Patients with CHD or Other Vascular Diseasewith CHD or Other Vascular Disease

Adapted from the UCLA CHAMP Guidelines 1994Adapted from the UCLA CHAMP Guidelines 1994

Risk ReductionRisk Reduction

ASA 20-30% Beta Blockers 20-35% ACE inhibitors 22-25% Statins 25-42%

The four medications every atherosclerosis patient should be treated with, unless contraindications exist and are documented

““Despite compelling scientific evidence and Despite compelling scientific evidence and national treatment guidelines supporting the national treatment guidelines supporting the use of secondary prevention medical use of secondary prevention medical therapies, these treatments continued to be therapies, these treatments continued to be underutilized in CVD patients receiving underutilized in CVD patients receiving conventional care” conventional care”

Adapted from 27th Bethesda Conference Report JACC 1997;27:958

Provider awareness does not equal successful implementation

Pearson Arch Intern Med 2000;160:459-67

CAD Treatment Gap - CommunityCAD Treatment Gap - Community

Physician Awareness of NCEP Guideline

Patient Treatedto Goal

95

18

0

20

40

60

80

100

An academic environment does not equal successful implementation

CAD Treatment Gap - Academic CentersCAD Treatment Gap - Academic Centers

Brigham and Women’s Hospital: 2003 outpts with CAD Arch Intern Med 2001:161:53-58LDS Hospital: 600 CAD patients discharged post cath Am J Card 2001;87:256-261Cleveland Clinic: 537 Diabetics with CAD Post PTCA JACC 1999;33:1269-77PURSUIT Trial Centers: 8515 ACS patients JACC 2000;35:411A

27.118 14.9

25.1

0

20

40

60

80

100P

rec

en

t o

f P

at i

en

t s T

rea

t ed

TheBrigham

LDSHospital

ClevelandClinic

PURSUITTrial Centers

Lipid Lowering Medication Treatment Rates

Quality Assurance Program (QAP)Quality Assurance Program (QAP)

No LDL-CDocumented“No Therapy”

43%

At GoalAt Goal““On Therapy”On Therapy”

7%7%At GoalAt Goal

““No Therapy”No Therapy”4%4%

Not at Goal“On Therapy”

18%

Not at Goal“No Therapy”

14%No LDL-C

Documented“On Therapy”

14%

n = 48,586n = 48,586

Sueta C, et al. Am J Cardiol. 1999;83:1303-1307.

CAD Treatment Gap - HospitalCAD Treatment Gap - Hospital

ACC Evaluation of Preventive Therapeutics (ACCEPT) Data - Hospital data (N=50) 1996-97

Treatment Gap of 80 % Treatment Gap of 80 % NRMI 3 Data - 1998-1999

32 % of Post-MI patients discharged on a lipid lowering agent 32 % of Post-MI patients discharged on a lipid lowering agent (N = 138,001) (N = 138,001)

Treatment gap is not a deficit of knowledge, rather it is a deficit of implementation

Pearson, T.A. et al., Supplement to Circulation: Oct, 1997;96:8:1733Fonarow Circulation 2001;103:38-44.

ACCEPT: Most Hospitalized CHD Patients are Not ACCEPT: Most Hospitalized CHD Patients are Not at Goal 6 Months Post Discharge at Goal 6 Months Post Discharge

Risk Factor GoalRisk Factor Goal OnOnAdmissionAdmission

At DischargeAt Discharge 6 mo. Post6 mo. PostDischargeDischarge

LDL-C < 100mg/dLLDL-C < 100mg/dL 0%0% 0%0% 24%24%

Lipid Lowering DrugLipid Lowering Drug 21%21% 24%24% 59%59%

AspirinAspirin 44%44% 86%86% 87%87%

Beta BlockerBeta Blocker 34%34% 58%58% 63%63%

Pearson, T.A. et al., Supplement to Circulation: Oct, 1997;96:8:1733.

68.3%

31.7%

No Lipid Lowering Lipid Lowering

138,001 patients discharged post AMI from 1470 US hospitals, July 1998 to June 1999Fonarow Circulation 2001;103:38-44

Independent Predictors

Teaching Hospital

Smoking Cessation

Catheterization

Use of Beta Blocker

CABG

decreased increased

Utilization of Lipid-Lowering Medications Utilization of Lipid-Lowering Medications at Discharge in Patients with AMIat Discharge in Patients with AMI

138,001 Patients in the National Registry of Myocardial Infarction-3

"Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction" Fonarow Circulation 2001;102:38-44

<55 55-64 65-74 75-84 85+

Age (Years)

0

20

40

60

80

100Male (N=83,806)

Female (N=54,195)

% D

isch

a rge

d on

Lip

id T

her a

py

P<0.0001 P<0.0001P<0.0001

P=NS

P=NS

Utilization of Lipid-Lowering Medications Utilization of Lipid-Lowering Medications at Discharge in Patients with AMIat Discharge in Patients with AMI

OFFICE SETTING

QAP DATA 30-40% Documented

Treatment Rate Treatment Gap of 66%

BURDEN OF DISEASE 23 million CHD patients in

the US

HOSPITAL SETTING

NRMI / ACCEPT DATA 20-32% Documented Treatment

Rate Treatment Gap of 68-80%

BURDEN OF DISEASE 2.7 million annual CHD discharges

in the US

CVD Treatment GapCVD Treatment Gap

National Hospital Discharge RatesNational Hospital Discharge Ratesfor Secondary Preventionfor Secondary Prevention

Report from 7/99 to 6/00NRMI Registry Discharge Medications at 1552 National NRMI III Hospitals (n=167,312)Includes all patients (no exclusions for contraindications or intolerance)

77

65

4237

42

ASA Beta blocker ACEI Statin Smoking0

20

40

60

80

100

Pe

rce

nt

of

Pa

tie

nts

Cessation

Physician is focused on acute problems

Time constraints and lack of incentives, including reimbursement

Lack of training including inadequate knowledge of benefits and lack of prescription experience

Lack of resources and facilities

Lack of specialist-generalist communication; passing on responsibility

Barriers to Implementing Risk Factor ManagementBarriers to Implementing Risk Factor Managementin Patients with Documented Coronary Artery Diseasein Patients with Documented Coronary Artery Disease

Adapted from 27th Bethesda Conference Report JACC 1997;27:958

Guidelines and treatment pathways which delay therapy and call for multiple steps, laboratory tests, and time points

Incentives for ChangeIncentives for Change NCQA/HEDIS/JCAHO/GOA reporting measures

– HospitalsHospitals

– Managed CareManaged Care

– PhysiciansPhysicians

Consumer demand for quality care / report cards

Graded on

– ASA after AMIASA after AMI

– Beta blocker after AMIBeta blocker after AMI

– ACEI after AMI and CHFACEI after AMI and CHF

– LDL evaluated/Rxed post cardiac hospitalizationLDL evaluated/Rxed post cardiac hospitalization

CVD Treatment System GoalsCVD Treatment System Goals

Implement initiatives to put evidence based guidelines into action

Improve the quality of care for patients with established cardiovascular disease

Reduce secondary events - and save lives

Optimal Hospital Discharge RatesOptimal Hospital Discharge Ratesfor Secondary Preventionfor Secondary Prevention

Indicator Rate Optimal

ASA 85%* 100%

Beta Blocker 72%* 100%

ACE-I 71%* 100%

Smoking Cessation 40%* 100%

Lipid Lowering 32%** 100%

*HCFA 1998 and **NRMI 1999

Optimal: UCLA Cardiology Performance Improvement Committee (patients without contraindications or medical intolerance)

Why a Hospital Based System?Why a Hospital Based System?Why a Hospital Based System?Why a Hospital Based System?

Patients–Patient Capture PointPatient Capture Point

–Have patients/family attention: “teachable moment’Have patients/family attention: “teachable moment’

–Predictor of care in communityPredictor of care in community Hospital Structure

–Standardized processes/protocols/orders/teamsStandardized processes/protocols/orders/teams

– JCAHOJCAHO• Process Improvement ExamplesProcess Improvement Examples

–HCFA--Peer Review OrganizationsHCFA--Peer Review Organizations• Six Scope of WorkSix Scope of Work

In-Hospital Initiation of Risk Factor In-Hospital Initiation of Risk Factor Modification and Cardioprotective TherapiesModification and Cardioprotective Therapies

Initiation of interventions for smoking cessation while patients are hospitalized with AMI has been shown to result in higher cessation rates then similar interventions initiated in the outpatient setting(1 year cessation rate of 71% vs 45%, P<0.01)

The UCLA Comprehensive Heart Failure Management Program demonstrated a 96% utilization rate of ACEI at 6 months when treatment was initiated at the time of hospitalization, a rate which was significantly higher as compared to conventionally managed outpatients

Taylor Annals Intern Med 1990;113:118-123Fonarow JACC 1997;30:725-732

CHD Patient Flow in the HospitalCHD Patient Flow in the Hospital

Lab

ER

Cath

ICU/CCU

Cardiology

Medicine

Telemetry

Pharmacy

QualityControl

DischargeNurse

InpatientRehab

6 Million

Discharged

2.7Million

OutpatientRehab

GroupPractice

10%

Cardiologist

Family Practice

LOST

Advocate/ChampionAdvocate/Champion

AcuteCoronary

Event

Inpatient Care

Outpatient Care

Protocol development process Implementation

Challenges to In-Hospital Initiation Challenges to In-Hospital Initiation of Lipid Lowering Treatmentof Lipid Lowering Treatment

BARRIERS1. Communication gaps - cardiologists vs

PCPs

2. Lack of ownership - acute vs chronic disease dilemma

3. Poor lab standardization and reporting

4. Lack of financial incentives

5. Lack of tools/resources

6. Lack of proof of concept

SOLUTIONS1. Education and mobilizing case management teams

2. Hospital is the capture point for patients with acute disease

3. Routine lipid testing for CHD patients by protocol

4. Joint Commission, NCQA, PROs will be measuring and reporting

5. HCFA - 6 scope of work, Joint Commission, ORYX are standardizing measurement tools

6. UCLA CHAMP demonstrates improved treatment rates and outcomes

the lipid panel in not accurate when drawn in the hospital

the primary care physicians will not agree to this

this will not work in a community hospital

the physicians at my hospital do not like cookbook medicine

the cardiologists will not agree to this

it may not be safe to start lipid lowering medications in hospitalized patients

the patients should all be followed in my lipid clinic

patients do not want to be on a lot of medications

the hospital administration will not pay for it

the managed care organization will not pay for it

we can not get a consensus

it will cost too much

we do not have anyone to collect this data

it will take too much time

it is too hard to get things through the hospital committee

this will benefit the competition

there is not enough time

there are exceptions x, y, and z

what about the liability

Challenges to a Hospital Based SystemChallenges to a Hospital Based System

Design of the UCLA Cardiovascular Hospitalization Design of the UCLA Cardiovascular Hospitalization Atherosclerosis Management Program :CHAMPAtherosclerosis Management Program :CHAMP

Based on hypothesis that physician use of and patient compliance with secondary prevention therapies could be improved with a hospital based treatment initiation program

Focused on initiation of aspirin, beta blocker, ACE inhibitor, and statin dosed to achieve LDL < 100 mg/dl in all cardiovascular disease patients prior to hospital discharge

Use of preprinted orders, simple guidelines, educational lectures, discharge forms, and prospective monitoring of treatment use.

Started in 1994 and continues to be the standard of care at UCLA

Fonarow Circulation 1997;96(8):I-67

AtherosclerosisCoronaryCarotidPeripheral

ClinicalUltrasoundStress TestAngiographic

Aspirin, Beta Blocker, ACEIHMG Co A Reductase Inhibitor

Exercise and Dietary Counseling

6 weeksFasting Lipid Panel, LFTs

LDL < 100 mg/dl

Continue TreatmentRecheck in 3-6 months

LDL > 100 mg/dl

Advance dose and/oradd niacin, resin

Recheck 6 weeks

CHAMP Fonarow Am J Cardiol 2000; 85:10A-17A

Admission Lipid Panel, LFTs

Hospital Phase of care

Outpatient Phase of care

CHAMP Algorithm for Patients with Clinically CHAMP Algorithm for Patients with Clinically Evident AtherosclerosisEvident Atherosclerosis

Focused TreatmentGuidelines and Algorithm

Preprinted AdmitOrder Sheets

Discharge Forms and Outpt F/U Process

Patient EducationMaterials

Focused Lecturesby Opinion Leader

Measurement andUtilization Reports

Implementation of CHAMPImplementation of CHAMP

Fonarow Circulation 1997;96(8):I-67

Admit patient to the CCU / COU

Attending ________ Resident ________ Intern _______

Vital Signs: Diet: 2 gm Na Step II AHA 4 gm Na Step II AHA

Laboratories: CK and CK-MB q 8 x 3, Troponin I now and 6 hours Lipid panel (nonfasting) TC, LDL, HDL, TG ECG now and q AM x ___

Medications: Aspirin 325 mg PO qd or ________________ Beta Blocker: Metroprolol ________ mg PO bid or __________ ACE Inhibitor: _________ ___ mg PO ___ HMG CoA RI: _________ ___ mg PO ___

Smoking cessation program Cardiac rehabilitation referral

UCLA Division of Cardiology

Patient ID #UCLA Chest Pain/Unstable Angina Orders

Standardized Admission Order SheetsStandardized Admission Order Sheets

UCLA Comprehensive AtherosclerosisTreatment Program Medication Goals

1) All patients with coronary, other vasculardisease, or diabetes treated with aspirin*

2) All patients with coronary, other vasculardisease, or diabetes treated with a statin*(dosed to achieve LDL < 100 mg/dl)

3) All patients with coronary, other vasculardisease, or diabetes treated with an ACEinhibitor*

4) All patients with coronary, other vasculardisease, or diabetes treated with a betablocker*

* unless contraindicated, not tolerated, or reason for not using documented in the medical record

Achieve TargetsLDL < 100 mg/dl

BP < 140/90 mmHgSmoking Cessation

LDL Treatment to Goal Guide

Baseline % reduction to goalLDL Level of LDL < 100 mg/dl115 mg/dl 13%120 mg/dl 17%125 mg/dl 21%130 mg/dl 24%140 mg/dl 29%150 mg/dl 34%160 mg/dl 38%170 mg/dl 42%180 mg/dl 45%190 mg/dl 48%

Simvastatin Lovastatin Atorvastatin10 mg 22% 10 mg 22% 10 mg 34%20 mg 31% 20 mg 25% 20 mg 41%40 mg 38% 40 mg 31% 40 mg 48%80 mg 45% 80 mg 41% 80 mg 51%

Pravastatin Cerivastatin Fluvastatin10 mg 20% 0.3 mg 30% 20 mg 20%20 mg 25% 0.4 mg 34% 40 mg 27%40 mg 30% 0.8 mg 42% 80 mg 32%

Visit www.med.ucla.edu/champ for further details 2001 CHAMP, UCLA Division of Cardiology

Implementation of CHAMPImplementation of CHAMP

8286

74

92

68

76

148

158

1622

UA Acute MI Chest pain PTCA CABG CHF0

20

40

60

80

100

120

Sta

tin

Ut i

liza

tio

n R

ate

(%

)

Admit Discharge

1779 patients hospitalized for coronary heart disease 1994-1995Fonarow Am J. Card. 2000; 85:10A-17A

Improved Treatment Utilization Across All Patient Categories

Impact of CHAMP on Treatment RatesImpact of CHAMP on Treatment Rates

The UCLA-CHAMP ExperienceThe UCLA-CHAMP Experience

CAD Patient Treatment Rates

*Fonarow, G. et al. “Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP,” Abstract #364 from the 70th Scientific Sessions, American Heart Association, November, 1997.

Proof of ConceptProof of Concept

‘92-’93(n=256)

‘94-’95(n=302)

Hospital discharge: Aspirin Beta-Blocker ACEI Statin12-month follow-up: Statin LDL < 100 mg/dL

78%12% 4% 6%

10% 6%

92%61%56%86%

91%58%

LDL Pre-CHAMP 92/93 Post-CHAMP 94/95

< 100 mg/dl 6% 58%

100-130 mg/dl 15% 16%

130-160 mg/dl 18% 4%

> 160 mg/dl 14% 0%

Not Documented 48% 22%

Results: Adherence to NCEP Treatment GoalsResults: Adherence to NCEP Treatment Goalsin Patients One Year Post Myocardial Infarctionin Patients One Year Post Myocardial Infarction

Fonarow Am J Cardiol 2001;87:819-822

EventPre-CHAMP 92/93

(n=256)Post-CHAMP 94/95

(n=302)

Recurrent MI 20 (7.8%) 10 (3.1%)

CHF 12 (4.7%) 8 (2.6%)

Hospitalization 38 (14.8%) 23 (7.6%)

Sudden Death 3 (1.2%) 2 (0.6%)

Cardiac Mortality 13 (5.1%) 6 (2.0%)

Noncardiac Mortality 2 (0.8%) 2 (0.6%)

Total Mortality 18 (7.0%) 10 (3.3%)

Pre and Post CHAMP Clinical Event RatesPre and Post CHAMP Clinical Event Rates

Follow-up for one year after discharge after acute myocardial infarctionFonarow Am J Cardiol 2001;87:819-822

*

*

*

*

* P < 0.05

14.8

6.4

Pre-CHAMP Post-CHAMP02468

1012141618

Death or Recurrent MI %

RR 0.43p<0.01

256 AMI pts discharged in 92/93 pre-CHAMP compared to 302 pts in 94/95 post-CHAMPASA 78% vs 92%; Beta Blocker 12% vs 61%; ACEI 4% vs 56%; Statin 6% vs 86% Fonarow Am J Cardiol 2001;87;819-822

CHAMP ~ Impact on Clinical Outcomes in CHAMP ~ Impact on Clinical Outcomes in the First Year Post Hospital Dischargethe First Year Post Hospital Discharge

68

12

4 6

92

68

52

8891

72

64

8994

78

70

90

ASA Beta Blocker ACEI Statin0

20

40

60

80

100

92/93

94/95

96/97

98/99

77

NRMI Registry Discharge Medications at UCLA compared to 1437 NRMI Hospitals

28

41

59

NRMI

UCLA

98/99

CHAMP ~ Sustained Impact Over a 6 CHAMP ~ Sustained Impact Over a 6 Year PeriodYear Period

Comparison to National Rx Rates

The CHAMP Protocol was associated with a significant increase in treatment utilization at the time of hospital discharge of medications previously demonstrated to improve survival in patients with CAD.

Initiation of cholesterol lowering medications prior to hospital discharge is safe, results in a high rate of utilization during longer term follow-up, and results in a significant increase in patients reaching LDL < 100 mg/dl.

CAD risk factor modification and treatment can be systematically integrated into the treatment received during cardiac hospitalizations without additional resources or medical personnel and is considerably more effective than conventional guidelines and care.

"Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP" Fonarow Circulation 1997;96(8):I-67

Implementation of a Cardiovascular Hospitalization Implementation of a Cardiovascular Hospitalization Atherosclerosis Management Program: CHAMPAtherosclerosis Management Program: CHAMP

19,599 men and women < 80 yo discharged post AMI, 58 Swedish Hospitals, 1995-19985528 (28%) statin rx vs 14071 (72%) no statin rx, highest hospital rates of use 48%; lowest 12% Stenestrand JAMA 2001;285;430-436

Early Statin Treatment Early Statin Treatment and Survival in AMIand Survival in AMI

0 100 200 300 400

Postadmission Days

0

1

2

3

4

5

6Mortality by Statin Treatment %

No Statin

Statin

RR 0.75 (0.63-0.89)

P=0.001

25% Risk Reduction

In-Hospital Lipid Lowering TherapyIn-Hospital Lipid Lowering Therapyis Associated with Markedly Lower Mortalityis Associated with Markedly Lower Mortality

10,288 patients with ACS OPUS-TIMI 163883 (38%) statin rx in hospital vs 6405 (62%) no statin rxCannon JACC 2001;35:334A

10.0%

90.0%

No Lipid Rx Lipid Rx

10 Month Compliance Rate

0 100 200 300 400

Postadmission Days

0

1

2

3

4

5

6Mortality by Statin Treatment %

No Lipid Rx

In-Hospital Lipid Rx

P<0.0001

42% RiskReduction

"Improved Treatment of Cardiovascular Disease by Implementation of a Cardiac Hospitalization Atherosclerosis Management Program: CHAMP" Fonarow Circulation 1997;96(8):I-67

Cardiovascular Hospitalization Atherosclerosis Management Program

Clinical ImplicationsClinical Implications

At present, a large number of patients with coronary artery and other atherosclerotic vascular disease are not receiving treatments that have been demonstrated to reduce recurrent cardiovascular events and mortality.

Widespread application of hospital based treatment programs such as GWTG could dramatically effect CVD treatment rates with proven cost-effective therapies and thus substantially reduce the risk of future coronary events and prolong life in the large number of patients hospitalized each year with CVD.

Problem: Problem: Large CVD treatment gap Large CVD treatment gap and poor patient compliance with and poor patient compliance with conventional managementconventional management

Solution: Solution: In-hospital initiation of In-hospital initiation of therapy with excellent treatment rates therapy with excellent treatment rates and long term patient complianceand long term patient compliance

Simple, Rapid, and Most Importantly EffectiveSimple, Rapid, and Most Importantly Effective

Sidney Smith MDAHA Chief Science Officer

“The CHAMP study shows that the key to keeping heart disease patients alive is providing them with immediate and thorough treatment before they walk out of the hospital”

“This study provides the scientific foundation for programs similar to CHAMP such as the AHA’s new hospital-based quality improvement program called Get With The Guidelines”

What’s Involved in Starting a Hospital What’s Involved in Starting a Hospital Based Treatment ProgramBased Treatment Program

Collect baseline data or use existing data source– i.e. NRMI IV or collect data with discharge nurse, medical student, etc.i.e. NRMI IV or collect data with discharge nurse, medical student, etc.

Appoint team to develop treatment algorithm, preprinted orders, discharge forms

Present at lectures and staff in-services– present resultspresent results

– review successes and failuresreview successes and failures

– lead discussion regarding recommendations on protocol improvement lead discussion regarding recommendations on protocol improvement

Revise Protocol to close Gaps Communicate Revisions to Key departments Repeat cycle every quarter = CQI

Assess CHD Treatment Rates

Evaluate Assessment

Refine Protocol

Implement Refined Protocol

Continuous Quality Improvement Continuous Quality Improvement (CQI) Process(CQI) Process

Continuous Quality Improvement Continuous Quality Improvement (CQI) Process(CQI) Process

Mobilize GWTG Initiative•Establish “Buy In”•Identify “Champions”•Build Team

Plan & Prep Program•Attend CME Program•Develop Hospital Plan•Assign Roles & Responsibilities

Implement Program•Establish D/C Protocol•Collect Baseline Data•Obtain consensus

Monitor & Support•Collect & Report f/u Data•Review & Improve Process

Hospital BasedHospital BasedContinuous Quality Improvement (CQI) ProcessContinuous Quality Improvement (CQI) Process

Hospital BasedHospital BasedContinuous Quality Improvement (CQI) ProcessContinuous Quality Improvement (CQI) Process

What is the AHA“Get With What is the AHA“Get With the Guidelines” Program ?the Guidelines” Program ?

What is the AHA“Get With What is the AHA“Get With the Guidelines” Program ?the Guidelines” Program ?

Implemented by AHA Affiliates/Volunteers who will mobilize advocacy networks at the Affiliate level to:

Implement CME-driven educational programs Provide workshops for dissemination of guidelines Develop care maps Formalize a national discharge protocol Implement discharge protocols in hospital setting Identify best practices for AHA recognition awards Develop and disseminate reports and publications Measure changes and report outcomes data Drive impact into communities

GWTG Tools and ResourcesGWTG Tools and Resources

AHA/ACC Guidelines AHA National Discharge Protocol/Discharge Form Template Care maps - ED, cath lab, etc. CME programs AHA National teleconferences Public Service Announcements National and regional advocates

www.med.ucla.edu/champ

www.americanheart.org

Secondary Prevention: Secondary Prevention: Making it a RealityMaking it a Reality

A major CHD treatment gap still exists

The hospital is the ideal capture point, provides a teachable moment, and predicts care in the community

Programs like CHAMP improve treatment rates and saves lives, making it essential that each hospital implement a prospective process to help improve CHD patient care immediately

Measure and report treatment rates to ensure CHD patient care is optimal