The association between guideline-based treatment instructions at the point of discharge and lower 1-year mortality in Medicare patients after acute myocardial infarction: The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative in Michigan - 16/08/11
on behalf of the American College of Cardiology Foundation Bethesda, MDn
Résumé |
Background |
The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative for acute myocardial infarction (AMI) has been shown to increase the use of guideline-based therapies and improve outcomes in patients with AMI. It is unknown whether hospitals that are more successful in using the standard discharge contract—a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning—experience a proportionally greater improvement in patient outcomes.
Methods |
Medicare patients treated for AMI in all 33 participating GAP hospitals in Michigan were enrolled. We aggregated the hospitals into 3 tertiles based on the rates of discharge contract use: 0% to 8.4% (tertile 1), >8.4% to 38.0% (tertile 2), and >38.0% to 61.1% (tertile 3). We analyzed 1-year follow-up mortality both pre- and post-GAP and compared the mortality decline post-GAP with discharge contract use according to tertile.
Results |
There were 1368 patients in the baseline (pre-GAP) cohort and 1489 patients in the post-GAP cohort. After GAP implementation, mortality at 1 year decreased by 1.2% (P = .71), 1.2% (P = .68), and 6.0% (P = .03) for tertiles 1, 2, and 3, respectively. After multivariate adjustment, discharge contract use was significantly associated with decreased 1-year mortality in tertile 2 (odds ratio 0.43, 95% CI 0.22-0.84) and tertile 3 (odds ratio 0.45, 95% CI 0.27-0.75).
Conclusions |
Increased hospital utilization of the standard discharge contract as part of the GAP program is associated with decreased 1-year mortality in Medicare patient populations with AMI. Hospital efforts to promote adherence to guideline-based care tools such as the discharge contract used in GAP may result in mortality reductions for their patient populations at 1 year.
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| The Guidelines Applied in Practice projects for acute myocardial infarction care were supported by unrestricted grants from the national American College of Cardiology Foundation, the Michigan chapter of the American College of Cardiology, the Centers for Medicare and Medicaid Services, the Michigan Peer Review Organization, the Medicare Quality Improvement Organization for the State of Michigan, Pfizer Inc, AstraZeneca, the Greater Detroit Area Health Council, the Greater Flint Health Coalition, the Mardigian Foundation, and the University of Michigan. |
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| The analyses upon which this publication is based were performed under Contract Number 500-02-MI-02, “Utilization and Quality Control Peer Review Organization for the State of Michigan,” and sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services; nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Feedback to the authors concerning the issues presented is welcomed. |
Vol 154 - N° 3
P. 461-469 - septembre 2007 Retour au numéro
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