title: Improving Guideline Compliance in Australia With a National Percutaneous Coronary Intervention Outcomes Registry.
abstract: BACKGROUND
  Secondary prevention strategies after percutaneous coronary intervention (PCI) include statins and dual anti-platelet therapy, however there are significant gaps between guidelines and practice. Contemporary PCI practice requires comprehensive data collection to allow dynamic auditing and benchmarking of key performance and safety indices. Genesis HeartCare is Australia's largest collaborative venture of cardiologists, practising at over 40 public and private hospitals. We hypothesised that measurement and local reporting of data would improve patient outcomes through improving compliance with guideline therapies.
  
  
  METHODS
  Real-time benchmarking via a national clinical quality and outcomes register, the Genesis Cardiovascular Outcomes Registry (GCOR-PCI). GCOR-PCI prospectively collected clinical, procedural, medication and outcomes data for 6720 consecutive patients undergoing PCI from 10 private hospitals across Australia. Key performance outcomes benchmarked against the aggregated study cohort and international standards were reported to individual sites. The main outcome measure was compliance with guideline medications (statins, anti-platelet agents).
  
  
  RESULTS
  Early data identified specific practice patterns associated with lower rates of statin therapy post-PCI, which led to changes in practice. Between the first and latest year of data collection there was significant improvement in the rates of statin therapy at discharge (92.1 vs. 94.4% p<0.03) and 12 months post-PCI (87.0 vs. 92.2% p<0.001) and of antiplatelet therapy at 12 months (90.7 vs. 94.3% p<0.001).
  
  
  CONCLUSIONS
  This large-scale collaboration provides a platform for the development of quality improvement initiatives. Establishment of this clinical quality registry improved patient care by identifying and monitoring gaps in delivery of appropriate therapies, driving key practice change.
authors.affiliation: GenesisCare, Sydney, NSW, Australia, Department of Medicine, University of Melbourne, Melbourne, Vic, Australia, Cardiology Department, Royal Melbourne Hospital, Melbourne, Vic, Australia. Electronic address: david.eccleston@mh.org.au.
authors.forename: David
authors.initials: D
authors.lastname: Eccleston
authors.affiliation: Austin Health, HeartCare Victoria, Melbourne, Vic, Australia. Electronic address: Mark.Horrigan@hcvic.com.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Horrigan
authors.affiliation: HeartCare Partners Brisbane, Qld, Australia. Electronic address: TRafter@heartcarepartners.com.au.
authors.forename: Tony
authors.initials: T
authors.lastname: Rafter
authors.affiliation: HeartCare Partners Brisbane, Qld, Australia. Electronic address: gwholt@heartcarepartners.com.au.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Holt
authors.affiliation: Royal Adelaide Hospital Adelaide Cardiology, Adelaide, SA, Australia. Electronic address: Stephen.Worthley@genesiscare.com.au.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
authors.affiliation: Adelaide Cardiology, Adelaide, SA, Australia. Electronic address: psage@adelaidecardiology.com.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Sage
authors.affiliation: HeartCare WA, Perth, WA, Australia. Electronic address: alan.whelan@heartcarewa.com.au.
authors.forename: Alan
authors.initials: A
authors.lastname: Whelan
authors.affiliation: NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University Director, CCRE Therapeutics, Monash University, Melbourne, Vic, Australia. Electronic address: christopher.reid@curtin.edu.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Reid
authors.affiliation: Cardiologist and Director of the Heart Research Institute Sir Charles Gairdner Hospital Clinical Professor of Medicine University of Western Australia Deputy Director, Harry Perkins Institute of Medical Research, Perth, WA, Australia. Electronic address: peterlthompson@bigpond.com.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D001315:Australia / Q000453:epidemiology; D019985:Benchmarking / Q000379:methods; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D010349:Patient Compliance; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D011182:Postoperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D058996:Quality Improvement; D012042:Registries; D055502:Secondary Prevention / Q000592:standards*
keywords: Compliance.; Coronary intervention; Guidelines; Outcomes; Percutaneous; Quality; Registry