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
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.
aUniversity of Rochester Medical Center, Rochester, NY
bDuke Clinical Research Institute and Duke University Medical Center, Durham, NC
cVeterans Affairs Palo Alto Health Care System, Palo Alto, CA
Reprint requests: Ying Xian, MD, Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 644, Rochester, NY 14642
ABSTRACT