Addressing Systems Change for Heart Disease and Stroke Prevention through GWTGPatient Management Too

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Addressing Systems Change for Heart Disease and
Stroke Prevention through GWTG-Patient Management
Tool

• Presentation to
• Council of State Governments Health Policy Forum
• On Cardiovascular Health and Wellness
• September 28, 2006
• Brian Boisseau
• Program Manager
• Heart Disease and Stroke Prevention Program
• Kentucky Department for Public Health

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Houstonwe have a problem

• Kentucky has higher than national averages in
  heart disease and stroke.
• Kentucky has higher rates of hypertension in
  whites and blacks than rest of the nation.
• Kentucky has the highest smoking rate in the
  nation.
• Kentucky average for cholesterol higher than
  nation.
• No statewide network for system change.

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Houstonwe have a problem

• Health care costs increasing due to risk factors
  of heart disease and stroke.
• Health care not always provided equally.
• How do we get to the 2010 goals if we keep doing
  the same things the same way?
• If you always do what you always did, youll
  always get what you always got!
• See the need, do the deed!

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CDCMission Control

• Promote policy and system change to assure
  quality care through adherence to primary and
  secondary prevention guidelines.

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CDCMission Control

• Hospitals
• Implement American Heart Associations Get With
  the Guidelines for coronary artery disease and
  stroke quality improvement or Guidelines Applied
  in Practice (American College of Cardiology) to
  support implementation of ACC/AHA cardiovascular
  guidelines.
• Chief partners are state QIO and AHA.
• Similar strategies as listed in primary care.

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MISSION OUTCOMES

• Increase the number of people who have high blood
  pressure under control
• Increase the number of people with total blood
  cholesterol less than 200 mg/dL
• Increase the number of people who know the signs
  and symptoms of heart attack and stroke, the risk
  factors for heart disease and stroke, and the
  importance of calling 9-1-1
• Improve Emergency Response

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MISSION OUTCOMES

• Improve Quality of Care
• Eliminate Disparities in terms of race,
  ethnicity, gender, geography, or socioeconomic
  status
• Decrease mortality
• Decrease health care costs

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WHAT WAS THE MISSION?

• Implement Get With the Guidelines in 26 Kentucky
  Hospitals by the end of FY 2003.
• Evidence based guidelines developed by AHA and
  ACC.
• Provides guidelines based care to all patients,
  equaling the field for patients regardless of
  geography, race, socioeconomic statuseliminates
  disparities.

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One Small Step for Man.
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What is Get With The GuidelinesSM?
WHAT IS GWTG?

• The premier hospital-based quality improvement
  program for the American Heart Association
• Leverages the teachable moment immediately
  after a patient has had an acute event
• Tools that allow healthcare providers to
  concurrently assess treatment compliance

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What is Get With The GuidelinesSM?
WHAT IS GWTG?

• Provides a framework for Continuous Quality
  Improvement
• Winner of the 2004 Health and Human Services,
  Innovation in Prevention Award

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WHAT IS GWTG?
A prospective intervention process in the
hospital setting, for coronary artery disease,
heart failure, and stroke patients, designed to
significantly increase compliance with secondary
prevention treatment rates by the time of
discharge
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WHAT DOES GWTG DO?
Supports system improvements for coronary artery
disease, heart failure, and stroke
patients Encourages links between cardiologists,
neurologists, intensivists, primary care
physicians, and ancillary healthcare providers
Provides resources to build consensus and
establish and execute protocols
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WHAT DOES GWTG DO?
Get With The Guidelines offers hospitals a
Recognition Program which encourages hospitals to
excel by achieving 85 compliance in the
indicators for each module.
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WHAT DOES GWTG DO?
Get With The Guidelines offers hospitals three
(3) Performance Achievement Awards recognizing
hospitals that maintain a consistent, high level
of quality within the GWTG program.
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WHAT ARE THE MODULES?

• GWTG-Coronary Artery Disease (KY 2003)
• GWTG-Stroke (KY 2005)
• GWTG-Heart Failure (KY 2006)

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What are the CAD performance measures that need
85 adherence for recognition?

• Smoking Cessation counseling for current smokers
  or persons who have smoked within the last twelve
  (12) months
• Aspirin on Discharge
• Beta-blocker on Discharge
• ACE-I on Discharge
• Lipid lowering therapy on Discharge
• In eligible patients without contraindications
  (designated by CMS as Ideal Patients)

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What are the Stroke performance measures that
need 85 adherence for recognition?

• Percent of acute ischemic stroke patients who
  arrive at the ED at hospital within 120 mins of
  onset of stroke symptoms who receive IV t-PA
  within 180 mins of onset of stroke symptoms.
• Percent of ischemic stroke or TIA patients who
  receive antithrombotic medication within 48 hours
  of hospitalization.
• Percent of ischemic stroke or TIA patients
  discharged on antithrombotics.
• Percent of ischemic stroke or TIA patients with
  atrial fibrillation who are discharged on
  anticoagulation therapy.

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Continued
What are the Stroke performance measures that
need 85 adherence for recognition?

• 5. Percent of patients at risk for DVT who
  received DVT prophylaxis by the 2nd hospital day.
• 6. Percent of ischemic stroke or TIA patients
  with LDL100 mg/dL OR on cholesterol reducer
  prior to admission who are discharged on
  cholesterol reducing drugs.
• 7. Percent of smokers who receive smoking
  cessation advice or medication.

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What are the Heart Failure performance measures
that need 85 adherence for recognition?

• HF Discharge instructions provided to all
  eligible patients
• Measurement of LV function in all eligible
  patients
• ACE inhibitor and/or ARB at discharge provided to
  eligible patients with LVEF
• Beta blocker at discharge provided to eligible
  patients.
• Smoking cessation counseling provided to all
  eligible patients (current or recent smokers)

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What Did We Do?

• Trained hospitals at statewide workshop with
  partners.
• AHA provided training/education and we helped
  support the education materials and facilities
  for training.
• KY CVH program served as facilitators.
• Program was successful.
• 26 Hospitals contracted to do GWTG.
• Follow-up GWTG Quality Improvement Workshop in
  January 2004

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Who Was Involved

• American Heart Association
• Kentucky Hospital Association
• Health Care Excel (Kentucky Medicare QIO)

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What Happened After?

• Through the continuance of implementing GWTG w/
  Stroke module, formed partnership with the
  University of Louisville Stroke Team.
• Partnership developed into contract for services.
• U of L provided provider education, nursing
  symposium, EMS education, and community education
  in Louisville DMA, to affect the stroke systems
  of care.

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What Happened After?

• Heart Disease and Stroke Program Manager invited
  to speak to Get Healthy Kentucky Board about
  state of stroke in Kentucky.
• Manager invited Dr. Remmel to attend and present
  as well.
• AHA presented on their efforts.

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What Happened After?

• Dr. Remmel made impression on board.
• Change was sought at licensure level for
  hospitals who claim to be Stroke Centers to be
  JCAHO Stroke Center Certified.
• Not successful in licensure change.
• Dr. Remmel invited to speak to legislature by
  AHA.
• Resolution adopted by senate to Urge the
  development of stroke systems of care.

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GWTG Module Data - Hospitals
Data Current as of August 31, 2006
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GWTG Module Data - Patients Enrolled
Data Current as of August 31, 2006
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RECOGNITION PROGRAM
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CONTACT INFORMATION

• Brian Boisseau, Program Manager
• Heart Disease and Stroke Prevention Program
• Kentucky Department for Public Health
• 275 E Main St, HS2W-E
• Frankfort, KY 40621
• Tel [phone] ext. 3823
• Fax [phone]
• Email Brian.Boisseau_at_ky.gov