Elsevier

American Heart Journal

Volume 159, Issue 2, February 2010, Pages 207-214
American Heart Journal

Clinical Investigation
Coronary Artery Disease
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

https://doi.org/10.1016/j.ahj.2009.11.002Get rights and content

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.

Section snippets

GWTG-CAD program

Details of the GWTG Program have been previously published.9 In brief, the AHA launched the GWTG initiative focused on the redesign of hospital systems of care to improve the quality of care of patients with CAD, stroke, and heart failure. The GWTG-CAD program includes learning sessions, didactic sessions, best practice sharing, interactive workshops, postmeeting follow-up, and a Web-based patient management tool (Outcome, Cambridge, MA). This Web-based tool provides the opportunity for

Results

The process by which hospitals were chosen for the study is presented in Figure 1. Overall, about 4,000 hospitals were identified in the Hospital Compare database during each 12-month period. About 7% of hospitals were excluded because of missing covariates in the GWTG database or the American Hospitals Association Annual Survey. To achieve data stability and reliability, we also excluded hospitals with less than 10 AMI admissions in each 12-month period. A total of 440, 439, and 429 GWTG-CAD

Discussion

GWTG-CAD is a collaborative performance improvement program of the AHA that aims to improve quality of care and clinical outcomes of patients hospitalized with CAD. Using the national CMS Hospital Compare data, we found that hospitals participating in GWTG-CAD hospitals had modestly higher overall acute cardiac care and secondary prevention guideline adherence relative to non–GWTG-CAD hospitals. In addition, these benefits associated with GWTG participation were sustained for 3 consecutive

Disclosures

GWTG-CAD is a program of the American Heart Association (Dallas, TX) and is supported in part by an unrestricted educational grant from Merck/Schering-Plough Pharmaceutical (White House Station, NJ) and Pfizer (New York, NY). The analysis of registry data was performed at Duke Clinical Research Institute (Durham, NC), which receives funding from the American Heart Association. The sponsors were not involved in the design, analysis, preparation, review, or approval of this manuscript.

Ying Xian,

References (14)

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