Performance achievement award program for Get With The Guidelines--Coronary Artery Disease is associated with global and sustained improvement in cardiac care for patients hospitalized with an acute myocardial infarction.
BACKGROUND
Adherence to evidence-based guidelines for the treatment of coronary artery disease (CAD) is suboptimal. Our goal was to determine whether the performance achievement award program for Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) was associated with global and sustained adherence to evidence-based guidelines for acute myocardial infarction.


METHODS
Adherence to evidence-based guidelines was assessed in 170,061 hospitalized acute myocardial infarction patients from 418 US hospitals participating in GWTG-CAD from 2000 to 2008. Hospitals that received a performance achievement award by attaining 85% adherence with 6 GWTG performance measures for at least 12 consecutive months were compared with those that had enrolled in the GWTG-CAD and had not attained this level of adherence. The outcome measures were change in adherence for 6 GWTG performance measures, 9 GWTG quality measures, a composite score, and an all-or-none measure. Generalized estimating equations were used to provide valid inference accounting for the within site correlation.


RESULTS
Hospitals that maintained 85% adherence with GWTG performance measures for at least 12 consecutive months had a higher composite score (94.78 +/- 15.99% vs. 89.72 +/- 21.37, P < 0.0001) and an all-or-none measure (87.17% vs. 75.15%, P < 0.0001) compared with hospitals that had not yet attained this level of adherence. Hospital adherence with performance and quality measures generally improved over time.


CONCLUSIONS
In conclusion, the performance achievement award program for GWTG-CAD was associated with global and sustained adherence to evidence-based guidelines. Our data suggest that this tool is a useful component of a quality improvement initiative and should be considered for other similar programs.
Birtcher
Kim K
KK
Clinical Sciences and Administration, University of Houston College of Pharmacy, 1441 Moursund, Houston, TX, USA. kbirtcher@uh.edu
Pan
Wenqin
W
Labresh
Kenneth A
KA
Cannon
Christopher P
CP
Fonarow
Gregg C
GC
Ellrodt
Gray
G
D000124:Achievement; D000368:Aged; D000572:American Heart Association / Q000458:organization & administration*; D001363:Awards and Prizes; D003324:Coronary Artery Disease / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D014943:Global Health; D019983:Guideline Adherence / Q000458:organization & administration*; D019538:Health Care Surveys; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D005791:Patient Care / Q000592:standards; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000592:standards*; D058996:Quality Improvement / Q000706:statistics & numerical data; D014481:United States