Get with the guidelines for cardiovascular secondary prevention: pilot results.
BACKGROUND
The use of Web-based technology and a collaborative model to improve hospital adherence to secondary prevention guidelines has not been previously evaluated.


METHODS
Twenty-four hospitals in Massachusetts participated in a collaborative that met quarterly, with didactic and best-practice presentations and interactive multidisciplinary team workshops. A customized tool kit and interactive, Web-based management tool were used for data collection and on-line feedback. Data from 1738 patients admitted with coronary artery disease were collected by hospital staff from July 1, 2000, to June 30, 2001. Outcome measures included differences between baseline and 10- to 12-month follow-up measurements of use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, cholesterol measurement and treatment, smoking cessation counseling, blood pressure control, and cardiac rehabilitation referral.


RESULTS
Clinically and statistically significant increases from baseline to 10- to 12-month follow-up were demonstrated in smoking cessation counseling (48% [95% confidence interval [CI], 36.6%-58.4%] to 87% [95% CI, 73.1%-100.7%]), lipid treatment (54% [95% CI, 46.6%-70.2%] to 79% [95% CI, 70.2%-88.3%]), lipid measurement (59% [95% CI, 51.5%-66.0%] to 81% [95% CI, 72.0%-89.5%]), and cardiac rehabilitation referral (34% [95% CI, 25.9%-39.7%] to 73% [95% CI, 63.2%-82.9%]). An improving trend was seen in blood pressure control (60% [95% CI, 55.3%-65.6%] to 68% [95% CI, 60.2%-76.1%]). High baseline use was maintained for use of aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors.


CONCLUSIONS
Implementation of a collaborative quality improvement initiative, interactive training of hospital teams with physician champions, and the use of an interactive Web-based Patient Management Tool enhanced adherence to prevention guidelines in hospitalized patients with coronary artery disease.
LaBresh
Kenneth A
KA
Department of Medicine, Brown University School of Medicine, Providence, RI, USA. Kalabresh@alum.mit.edu
Ellrodt
A Gray
AG
Gliklich
Richard
R
Liljestrand
James
J
Peto
Randolph
R
D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000628:therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003628:Database Management Systems; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D020407:Internet; D008297:Male; D008404:Massachusetts; D009203:Myocardial Infarction / Q000628:therapy; D010348:Patient Care Team; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods; D012737:Sex Factors