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Systems Approaches to Quality Care in Hospitals Kentuckys Get With the Guidelines Approach

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Title: Systems Approaches to Quality Care in Hospitals Kentuckys Get With the Guidelines Approach


1
Systems Approaches to Quality Care in Hospitals
Kentuckys Get With the Guidelines Approach
  • September 18, 2007
  • Bonita A. Bobo, RN, IBCLC
  • Program Manager
  • Heart Disease and Stroke Prevention Program
  • Kentucky Department for Public Health

2
The Kentucky Derby The Race is On
3
The Kentucky Problem-
  • Kentucky has the highest smoking rate in the
    nation.
  • Kentucky has higher than national averages in
    heart disease and stroke mortality.
  • Hypertension in Kentucky whites and blacks is
    higher than the national average for all adults.
  • Kentuckys average for high blood cholesterol is
    higher than the national average.
  • Kentucky has no statewide network for system
    change.

4
The Kentucky Problem-
  • Health care costs increasing due to risk factors
    of heart disease and stroke
  • Health care not always provided equally
  • How do we reach the 2010 goals if we keep doing
    the same things the same way?

5
The CDC Guidance-
  • Promote policy and system change to assure
    quality care through adherence to primary and
    secondary prevention guidelines.

6
Short Term 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

7
Long Term Outcomes
  • Improve quality of care
  • Eliminate disparities in terms of race,
    ethnicity, gender, geography, or socioeconomic
    status
  • Decrease mortality
  • Decrease health care costs

8
Partners
  • American Heart Association/American Stroke
    Association
  • Implement Get With the Guidelines for coronary
    artery disease, stroke and heart failure
  • Health Care Excel (Kentucky Medicare QIO)
  • Kentucky Hospital Association

9
What Path Should We Take?
  • Evidence based guidelines developed by AHA
  • Implement Get With the Guidelines in Kentucky
    hospitals
  • Provide guidelines-based care to all patients
    regardless of geography, race, socioeconomic
    status
  • Eliminate disparities

10
The Finish Line - Systems Change?
11
Get With The Guidelines (GWTG)
12
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
13
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

14
WHAT IS GWTG?
  • Provides a framework for Continuous Quality
    Improvement
  • Winner of the 2004 Health and Human Services,
    Innovation in Prevention Award

15
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

16
WHAT DOES GWTG DO?
Get With The Guidelines offers hospitals a
Recognition Program that encourages them to excel
by achieving 85 compliance in the indicators for
each module.
17
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.
18
GWTG MODULES
  • GWTG-Coronary Artery Disease (KY 2003)
  • GWTG-Stroke (KY 2004)
  • GWTG-Heart Failure (KY 2006)

19
CAD Performance Measures
  • 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)

20
Stroke Performance Measures
  • 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

21
Continued
  • 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 LDLgt100 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

22
Heart Failure Performance Measures
  • 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 lt or 0.40
  • Beta blocker at discharge provided to eligible
    patients
  • Smoking cessation counseling provided to all
    eligible patients (current or recent smokers)

23
What Path Did We Take? (The Process)
  • AHA provided training/education
  • HDSP program provided facilitation, education
    materials, facilities for training and initial
    funding source
  • Open invitation to all hospitals
  • Trained hospitals at statewide workshops with
    partners
  • QIO (Health Care Excel) spoke at workshops on
    quality improvement processes within the hospital
  • 26 hospitals contracted to do GWTG
  • Received funds to implement module(s)
  • Follow-up GWTG Quality Improvement Workshop in
    January 2004

24
Land Between the Lakes
25
Results
  • Partnership developed into contract with the
    University of Louisville Stroke Team for stroke
    systems of care
  • U of L provided
  • Provider education
  • Nursing symposium
  • EMS education, and
  • Community education

26
Results
  • Presentation to Get Healthy Kentucky Board on
    burden of stroke in Kentucky
  • Kentucky Heart Disease and Stroke Prevention
    Program Manager
  • University of Louisville Stroke Team Medical
    Director
  • American Heart Association

27
Results
  • University of Louisville Stroke Team Medical
    Director presented to Kentucky Legislature
  • Stroke Resolution adopted by senate to urge the
    development of a statewide system of stroke
    care. (2006)

28
GWTG Module Data - Hospitals
29
Kentucky GWTG Progress (Hospital Results)
30
Kentucky GWTG Progress (Hospital Results)
31
Kentucky GWTG Progress (Hospital Results)
32
Kentucky GWTG Progress (Hospital Results)
33
Kentucky GWTG Progress (Hospital Results)
34
Kentucky GWTG Progress (Hospital Results)
35
Kentucky GWTG Progress (Hospital Results)
36
Data Utilization
  • Outcome Sciences, Inc. houses data need 100
    data abstraction
  • quality improvement program helps hospitals
    collect and analyze information about their
    stroke care, and enables physicians and hospital
    staff to monitor their performance in real time
    with guidelines and national benchmarking
  • AHA is giving recognition to hospitals that excel
    by achieving 85 compliance in the indicators for
    each module
  • Hospital demographic data helps to identify where
    to expand GWTG in other hospitals to cover all of
    Kentucky

37
Performance Achievement Award Winners
  • Follow treatment guidelines in certain key
    measures at least 85 percent of the time and
    maintained for a period of time 90 Days, 12
    Months or gt24 Months

38
Award Winning Hospitals
  • The Medical Center Bowling Green Initial
    Performance Achievement Award for Coronary Artery
    Disease
  • Kings Daughters Medical Center-Ashland Initial
    Performance Achievement Award for Heart Failure
  • St Elizabeth Medical Center Edgewood - Initial
    Performance Achievement Award for Stroke
  • St Elizabeth Medical Center Edgewood - Initial
    Performance Achievement Award for Heart Failure

39
Award Winning Hospitals (cont)
  • University of Louisville Hospital Sustained
    Performance Achievement Award for Stroke
  • 1 of only 6 in the nation recognized for this
    exceptional award

40
Spotlighted in Recognition Ads
  • US News and World Report
  • Americas Top Hospital issue
  • (July 2007)
  • Circulation Journal (November 2007)
  • Stroke Journal (February 2008)

41
Lessons Learned
  • Hospitals willing to participate when given
    funding
  • Need to continue GWTG and expand into rural
    hospitals
  • Partnerships with UL, AHA, and KHA led to
    increase in number of JCAHO certified primary
    stroke centers (PSC)
  • Working to add three more PSC to cover all
    regions of state

42
One Hospitals Progress
43
Kentuckys Promise for a Brighter Tomorrow
44
CONTACT INFORMATION
  • Contact Info
  • Bonita A. Bobo, RN, IBCLC
  • Program Manager
  • 502-564-7996 ext. 3625
  • bonitaa.bobo_at_ky.gov
  • Tricia McLendon, MPH
  • Epidemiologist
  • 502-564-7996 ext. 3819
  • patricia.mclendon_at_ky.gov
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