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

Xian, Ying; Pan, Wenqin; Peterson, Eric D.; Heidenreich, Paul A.; Cannon, Christopher P.; Hernandez, Adrian F.; Friedman, Bruce; Holloway, Robert G.; Fonarow, Gregg C.; for the GWTG Steering Committee and Hospitals,

doi:10.1016/j.ahj.2009.11.002

« Previous Next »American Heart Journal
Volume 159, Issue 2 , Pages 207-214, February 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

Ying Xian, MD
- University of Rochester Medical Center, Rochester, NY
Wenqin Pan, PhD
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC
- Reprint requests: Ying Xian, MD, Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 644, Rochester, NY 14642
Eric D. Peterson, MD, MPH
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC
Paul A. Heidenreich, MD, MS
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
Christopher P. Cannon, MD
- TIMI Group and Harvard University, Boston, MA
Adrian F. Hernandez, MD, MHS
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC
Bruce Friedman, PhD, MPH
- University of Rochester Medical Center, Rochester, NY
Robert G. Holloway, MD, MPH
- University of Rochester Medical Center, Rochester, NY
Gregg C. Fonarow, MD
- UCLA Medical Center, Los Angeles, CA
for the GWTG Steering Committee and Hospitals

Received 19 September 2009; accepted 6 November 2009.

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 β-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) β-blocker at arrival (3.4%, 2.9%, and 2.6%), and (4) β-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.