Congestive heart failure clinical outcomes study in a private community medical group.
BACKGROUND
Although angiotensin-converting enzyme (ACE) inhibitor therapy has been shown to improve clinical outcomes of patients with systolic dysfunction, it has been underused or prescribed in inadequate dosages by physicians in the treatment of congestive heart failure. Our goal was to evaluate whether integration of a clinical guideline within a continuous quality improvement program would improve care for patients with congestive heart failure caused by systolic dysfunction.


METHODS
All patients of a private community medical group who were admitted to the hospital with congestive heart failure were studied prospectively for 21 months. An internally developed congestive heart failure practice guideline was presented to the group's physicians. The guidelines were available in the hospital computer system and were reinforced at monthly quality improvement meetings. Performance data were reviewed quarterly with the physicians.


RESULTS
Rates of classifying systolic vs diastolic dysfunction remained unchanged during the study. Use of ACE inhibitor therapy at the time of discharge improved substantially for patients with systolic dysfunction. Quarterly admissions of patients with systolic dysfunction declined 49% throughout the study period. No improvement was noted in the documentation of specific discharge instructions.


CONCLUSIONS
Use of a disease management guideline, ongoing physician education, and feedback of peer performance data to physicians significantly improved the quality and efficiency of care provided to patients with congestive heart failure in an independent, primary care medical group.
Civitarese
L A
LA
Preferred Primary Care Physicians, Pittsburgh, PA 15220, USA.
DeGregorio
N
N
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003154:Community Medicine; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D016019:Survival Analysis; D013599:Systole; D017749:Total Quality Management; D016896:Treatment Outcome; D018754:Ventricular Dysfunction; D016277:Ventricular Function, Left
D000806:Angiotensin-Converting Enzyme Inhibitors