Taking the national guideline for care of acute myocardial infarction to the bedside: developing the guideline applied in practice (GAP) initiative in Southeast Michigan.
BACKGROUND
The Guideline Applied in Practice (GAP) program was developed in 2000 to improve the quality of care by improving adherence to clinical practice guidelines. For the first GAP project, the American College of Cardiology (ACC) partnered with the Southeast Michigan Quality Forum Cardiovascular Subgroup and the Michigan Peer Review Organization (MPRO) to develop interventions that might facilitate the use of the ACC/AHA Acute Myocardial Infarction (AMI) guideline in the practice setting. Ten Michigan hospitals participated in implementing the project, which began in March 2000.
The project developed a multifaceted intervention aimed at key players in the care delivery triangle: the physician, nurse, and patient. Intervention components included a project kick-off presentation and dinner, creation and implementation of a customized tool kit, identification and assignment of local nurse and physician opinion leaders, grand rounds site visits, and measurement before and after the intervention.
The GAP project experience suggests that hospitals are enthusiastic about partnering with ACC to improve quality of care; partners can work together to develop a program for guideline implementation; rapid-cycle implementation is possible with the GAP model; guidelines and quality indicators for AMI are well accepted; and hospitals can adapt the national guideline for care into usable tools focused on physicians, nurses, and patients.


CONCLUSIONS
Important structure and process changes--both of which are required for successful QI efforts--have been demonstrated in this project. Ultimately, the failure or success of this initiative will depend on an indication that the demonstrated improvement in the quality indicators is sustained over time.
Eagle
Kim A
KA
Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA. Keagle@umich.edu
Gallogly
Meg
M
Mehta
Rajendra H
RH
Baker
Patricia L
PL
Blount
Angela
A
Freundl
Marge
M
Orza
Michele J
MJ
Parrish
Robert
R
Riba
Arthur L
AL
Montoye
Cecelia Kucyk
CK
D000572:American Heart Association; D016507:Cardiology Service, Hospital / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D008824:Michigan; D017146:Models, Organizational; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D010865:Pilot Projects; D019095:Point-of-Care Systems / Q000592:standards*; D017410:Practice Guidelines as Topic; D011366:Professional Review Organizations; D016730:Program Development / Q000379:methods; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012955:Societies, Medical