An organized approach to improvement in guideline adherence for acute myocardial infarction - Results with the Get With The Guidelines quality improvement program
An organized approach to improvement in guideline adherence for acute myocardial infarction - Results with the Get With The Guidelines quality improvement program
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DOI：
10.1001/archinte.168.16.1813
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发表时间：
2008-09-08
影响因子：
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通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
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作者：
Lewis, William R.;Peterson, Eric D.;Fonarow, Gregg C.
背景：来自美国心脏协会的循证指南是自愿的，并且在全国范围内的依从性差异很大。遵循指南（GWTG）是由美国心脏协会赞助和开发的国家质量改进计划。本研究的目的是评估参与GWTG是否与更严格地遵守冠状动脉疾病（CAD）指南相关。方法：根据2004年1月1日参与GWTG-CAD项目的医院进行分组，从医院比较中获取指南依从性数据：GWTG-CAD医院，n = 223；非GWTG-CAD医院，n = 3407。GWTG项目使用患者管理工具、教育和基准质量报告来提高指南的依从性。对8项国家措施的依从性进行分析，包括在出院早期和出院时使用阿司匹林和β受体阻滞剂以及时间轴再灌注。还计算了综合评分。采用多变量logistic回归比较两组间的复合依从率。结果：GWTG-CAD医院整体医院比较综合措施的依从性高于非GWTG-CAD医院（平均[SD] 89.7%[10.0%]比85.0[15.0%]；绝对增加4.7%;P < 0.001）。GWTG-CAD性能测量（PM）组合的依从性也更高（89.5% [11.0%]vs 83.0% [18.0%]; P < .001）。在多变量分析中，GWTG-CAD参与与PM组合依从性适度绝对增加2.52%相关（95%置信区间[CI]， 0.19%-4.85%）。较大的急性心肌梗死体积（绝对增加，14.2%;95% CI, 12.2%-16.3%）、东北部地理位置和教学医院状况（绝对增加，2.87%;95% CI, 0.43-5.32）也与PM组合依从性的提高有关。作为对照，GWTG-CAD参与医院对肺炎不相关质量指标的评价显示依从性较低（74.8% [7.3%]vs 76.1% [9.7%]; P = 0.005）。结论：参与GWTG-CAD与指南依从性的改善独立相关，而不是与公开报告相关。
Background: Evidence-based guidelines from the American Heart Association are voluntary, and adherence is highly variable across the country. Get With The Guidelines (GWTG) is a national quality improvement program sponsored and developed by the American Heart Association. The objective of this study was to evaluate whether participation in GWTG is associated with greater adherence to guidelines for coronary artery disease (CAD).Methods: Data on adherence to guidelines were obtained from Hospital Compare, grouping hospitals according to participation in the GWTG-CAD program on January 1, 2004: GWTG-CAD hospitals, n = 223; non GWTG-CAD hospitals, n = 3407. The GWTG program uses a patient management tool, education, and benchmarked quality reports to improve guideline adherence. Adherence to 8 national measures, including the use of aspirin and beta-blockers early and at discharge and timeline reperfusion, was analyzed. A composite score was also calculated. Multivariable logistic regression was performed for comparing composite adherence rates between groups.Results: Adherence to the overall Hospital Compare composite measure was higher in GWTG-CAD hospitals than in non-GWTG-CAD hospitals (mean [SD], 89.7% [10.0%] vs 85.0 [15.0%]; absolute increase, 4.7%; P < .001). Adherence to the GWTG-CAD performance measures (PM) composite was also higher (89.5% [11.0%] vs 83.0% [18.0%]; P < .001). In multivariate analysis, GWTG-CAD participation was associated with a modest absolute increase in adherence to the PM composite by 2.52% (95% confidence interval [CI], 0.19%-4.85%). Larger acute myocardial infarction volume by quartile (absolute increase, 14.2%; 95% CI, 12.2%-16.3%), geographic location in the Northeast, and teaching hospital status (absolute increase, 2.87%; 95% CI, 0.43-5.32) were also associated with improved adherence to the PM composite. As a control, evaluation of unrelated quality measures for pneumonia, showed lower adherence among GWTG-CAD participating hospitals (74.8% [7.3%] vs 76.1% [9.7%]; P = .005).Conclusion: Participation in GWTG-CAD was independently associated with improvements in guideline adherence beyond that associated with public reporting.