Journal ArticleDOI
Improving quality of care for acute myocardial infarction. The Guidelines Applied in Practice (GAP) initiative
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Implementation of guideline-based tools for AMI may facilitate quality improvement among a variety of institutions, patients, and caregivers and provides a foundation for future initiatives aimed at quality improvement.Abstract:
CONTEXT\nQuality of care of patients with acute myocardial infarction (AMI) has received intense attention. However, it is unknown if a structured initiative for improving care of patients with AMI can be effectively implemented at a wide variety of hospitals.\n\n\nOBJECTIVE\nTo measure the effects of a quality improvement project on adherence to evidence-based therapies for patients with AMI.\n\n\nDESIGN AND SETTING\nThe Guidelines Applied in Practice (GAP) quality improvement project, which consisted of baseline measurement, implementation of improvement strategies, and remeasurement, in 10 acute-care hospitals in southeast Michigan.\n\n\nPATIENTS\nA random sample of Medicare and non-Medicare patients at baseline (July 1998--June 1999; n = 735) and following intervention (September 1--December 15, 2000; n = 914) admitted at the 10 study centers for treatment of confirmed AMI. A random sample of Medicare patients at baseline (January--December 1998; n = 513) and at remeasurement (March--August 2001; n = 388) admitted to 11 hospitals that volunteered, but were not selected, served as a control group.\n\n\nINTERVENTION\nThe GAP project consisted of a kickoff presentation; creation of customized, guideline-oriented tools designed to facilitate adherence to key quality indicators; identification and assignment of local physician and nurse opinion leaders; grand rounds site visits; and premeasurement and postmeasurement of quality indicators.\n\n\nMAIN OUTCOME MEASURES\nDifferences in adherence to quality indicators (use of aspirin, beta-blockers, and angiotensin-converting enzyme [ACE] inhibitors at discharge; time to reperfusion; smoking cessation and diet counseling; and cholesterol assessment and treatment) in ideal patients, compared between baseline and postintervention samples and among Medicare patients in GAP hospitals and the control group.\n\n\nRESULTS\nIncreases in adherence to key treatments were seen in the administration of aspirin (81% vs 87%; P =.02) and beta-blockers (65% vs 74%; P =.04) on admission and use of aspirin (84% vs 92%; P =.002) and smoking cessation counseling (53% vs 65%; P =.02) at discharge. For most of the other indicators, nonsignificant but favorable trends toward improvement in adherence to treatment goals were observed. Compared with the control group, Medicare patients in GAP hospitals showed a significant increase in the use of aspirin at discharge (5% vs 10%; P<.001). Use of aspirin on admission, ACE inhibitors at discharge, and documentation of smoking cessation also showed a trend for greater improvement among GAP hospitals compared with control hospitals, although none of these were statistically significant. Evidence of tool use noted during chart review was associated with a very high level of adherence to most quality indicators.\n\n\nCONCLUSIONS\nImplementation of guideline-based tools for AMI may facilitate quality improvement among a variety of institutions, patients, and caregivers. This initial project provides a foundation for future initiatives aimed at quality improvement.read more
Citations
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Journal Article
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more
TL;DR: Elliott M. Antman,MD, FACC, FAHA, Chair; Daniel T. Anbe, MD, F ACC,FAHA; Paul Wayne Armstrong, MD; Eric R. Bates; Lee A. Green; Mary Hand; Judith S. Kushner; and Sidney C. Sloan.
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Health Professions Education: A Bridge to Quality
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TL;DR: Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education.
Journal ArticleDOI
ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more
TL;DR: This document was approved by the American College of Cardiology Foundation Board of Trustees on May 7, 2004 and by theAmerican Heart Association Science Advisory and Coordinating Committee on May 5, 2004.
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International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients With Atherothrombosis
Deepak L. Bhatt,P. Gabriel Steg,E. Magnus Ohman,Alan T. Hirsch,Yasuo Ikeda,Jean-Louis Mas,Shinya Goto,Chiau Suong Liau,Alain J. Richard,Joachim Röther,Peter W.F. Wilson +10 more
TL;DR: This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.
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Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines
TL;DR: Recommendations issued in current ACC/AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion, and the proportion of recommendations for which there is no conclusive evidence is also growing.
References
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Journal Article
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).
Elliott M. Antman,Daniel T. Anbe,Paul W. Armstrong,Eric R. Bates,Lee A. Green,Mary M. Hand,Judith S. Hochman,Harlan M. Krumholz,Frederick G. Kushner,Gervasio A. Lamas,Charles J. Mullany,Joseph P. Ornato,David L. Pearle,Michael A. Sloan,Sidney C. Smith,Joseph S. Alpert,Jeffrey L. Anderson,David P. Faxon,Valentin Fuster,Raymond J. Gibbons,Gabriel Gregoratos,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Alice K. Jacobs +24 more
TL;DR: Elliott M. Antman,MD, FACC, FAHA, Chair; Daniel T. Anbe, MD, F ACC,FAHA; Paul Wayne Armstrong, MD; Eric R. Bates; Lee A. Green; Mary Hand; Judith S. Kushner; and Sidney C. Sloan.
Book
Health Professions Education: A Bridge to Quality
Ann C. Greiner,Elisa Knebel +1 more
TL;DR: Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education.
Journal ArticleDOI
International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients With Atherothrombosis
Deepak L. Bhatt,P. Gabriel Steg,E. Magnus Ohman,Alan T. Hirsch,Yasuo Ikeda,Jean-Louis Mas,Shinya Goto,Chiau Suong Liau,Alain J. Richard,Joachim Röther,Peter W.F. Wilson +10 more
TL;DR: This large, international, contemporary database shows that classic cardiovascular risk factors are consistent and common but are largely undertreated and undercontrolled in many regions of the world.
Journal ArticleDOI
ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction
Thomas J. Ryan,Jeffrey L. Anderson,Elliott M. Antman,Blaine A. Braniff,Neil H. Brooks,Robert M. Califf,L. David Hillis,Loren F. Hiratzka,Elliott Rapaport,Barbara Riegel,R. O. Russell,Earl E. Smith,W. Douglas Weaver,James L. Ritchie,Melvin D. Cheitlin,Kim A. Eagle,Timothy J. Gardner,Arthur Garson,Raymond J. Gibbons,Richard P. Lewis,Robert A. O'Rourke +20 more
TL;DR: The American College of Cardiology and the American Heart Association request that the following format be used when citing this document: Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD.
Journal ArticleDOI
One-Year Cardiovascular Event Rates in Outpatients With Atherothrombosis
Ph. Gabriel Steg,Deepak L. Bhatt,Peter W.F. Wilson,Ralph B. D'Agostino,E. Magnus Ohman,Joachim Röther,Chiau-Suong Liau,Alan T. Hirsch,Jean-Louis Mas,Yasuo Ikeda,Michael J. Pencina,Shinya Goto +11 more
TL;DR: The reduction of atherosclerotic arterial disease (REACH) registry as discussed by the authors is an international, prospective cohort of 68,236 patients with either established coronary artery disease (CAD, PAD, CVD), or at least three risk factors for atherothrombosis (n = 12,422).