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Are quality improvements associated with the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program sustained over time? A longitudinal comparison of GWTG-CAD hospitals versus non-GWTG-CAD hospitals.

Publication ,  Journal Article
Xian, Y; Pan, W; Peterson, ED; Heidenreich, PA; Cannon, CP; Hernandez, AF; Friedman, B; Holloway, RG; Fonarow, GC ...
Published in: Am Heart J
February 2010

BACKGROUND: Previous reports have demonstrated that participation in GWTG-CAD, a national quality initiative of the American Heart Association, is associated with improved guideline adherence for patients hospitalized with CAD. We sought to establish whether these benefits from participation in GWTG-CAD were sustained over time. METHODS: We used the Centers for Medicare and Medicaid Services Hospital Compare database to examine 6 performance measures and one composite score for 3 consecutive 12-month periods including aspirin and beta-blocker on arrival/discharge, angiotensin-converting enzyme inhibitor (ACE-I) for left ventricular systolic dysfunction (LVSD), and adult smoking cessation counseling. The differences in guideline adherence between the GWTG-CAD hospitals (n = 440, 439, 429) and non-GWTG-CAD hospitals (n = 2,438, 2,268, 2,140) were evaluated for each 12-month period. A multivariate mixed-effects model was used to estimate the independent effect of GWTG-CAD over time adjusting for hospital characteristics. RESULTS: Compared with non-GWTG hospitals, the GWTG-CAD hospitals demonstrated higher guideline adherence for 6 performance measures. The largest differences existed for (1) aspirin at arrival (2.3%, 2.1%, and 1.6% for each 12-month period, respectively), (2) aspirin at discharge (3.4%, 2.2%, and 2.3%), (3) beta-blocker at arrival (3.4%, 2.9%, and 2.6%), and (4) beta-blocker at discharge (2.8%, 1.8%, and 1.5%). In multivariate analysis, the GWTG-CAD hospitals were independently associated with better adherence for 4 of the 6 measures (the exceptions were ACE-I for LVSD and smoking cessation counseling). Superior performance was also found for the composite measures. Although there was some narrowing between groups, GWTG-CAD hospitals maintained superior guideline adherence than non-GWTG-CAD hospitals for the entire 3-year period (adjusted differences 1.8%, 1.6%, and 1.4%). CONCLUSIONS: Hospitals participating in GWTG-CAD had modestly superior acute cardiac care and secondary prevention measures performance relative to non-GWTG-CAD. These benefits of GWTG-CAD participation were sustained over time and independent of hospital characteristics.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2010

Volume

159

Issue

2

Start / End Page

207 / 214

Location

United States

Related Subject Headings

  • Time Factors
  • Quality of Health Care
  • Longitudinal Studies
  • Humans
  • Hospitals
  • Guideline Adherence
  • Coronary Artery Disease
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
 

Citation

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Xian, Y., Pan, W., Peterson, E. D., Heidenreich, P. A., Cannon, C. P., Hernandez, A. F., … GWTG Steering Committee and Hospitals, . (2010). Are quality improvements associated with the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program sustained over time? A longitudinal comparison of GWTG-CAD hospitals versus non-GWTG-CAD hospitals. Am Heart J, 159(2), 207–214. https://doi.org/10.1016/j.ahj.2009.11.002
Xian, Ying, Wenqin Pan, Eric D. Peterson, Paul A. Heidenreich, Christopher P. Cannon, Adrian F. Hernandez, Bruce Friedman, Robert G. Holloway, Gregg C. Fonarow, and Gregg C. GWTG Steering Committee and Hospitals. “Are quality improvements associated with the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program sustained over time? A longitudinal comparison of GWTG-CAD hospitals versus non-GWTG-CAD hospitals.Am Heart J 159, no. 2 (February 2010): 207–14. https://doi.org/10.1016/j.ahj.2009.11.002.
Xian Y, Pan W, Peterson ED, Heidenreich PA, Cannon CP, Hernandez AF, Friedman B, Holloway RG, Fonarow GC, GWTG Steering Committee and Hospitals. Are quality improvements associated with the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program sustained over time? A longitudinal comparison of GWTG-CAD hospitals versus non-GWTG-CAD hospitals. Am Heart J. 2010 Feb;159(2):207–214.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2010

Volume

159

Issue

2

Start / End Page

207 / 214

Location

United States

Related Subject Headings

  • Time Factors
  • Quality of Health Care
  • Longitudinal Studies
  • Humans
  • Hospitals
  • Guideline Adherence
  • Coronary Artery Disease
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services