Get With The GuidelinesGet With The GuidelinesSMSM

Saving Lives…One Hospital, One Patient at a TimeSaving Lives…One Hospital, One Patient at a Time

September 28, 2006September 28, 2006

Present by:Present by:Mary Paulsen, MSN RNMary Paulsen, MSN RN

Quality Improvement DirectorQuality Improvement DirectorAmerican Heart Association/American Stroke AssociationAmerican Heart Association/American Stroke Association

Today’s Today’s AgendaAgenda

• Introduction to the American Heart Association

• The Critical Issue of Heart Disease and Stroke

• Challenges within Patient Care Today

• Get With The GuidelinesSM Creates a Culture of Quality

• Benefit of Get With The Guidelines

• Collaborative opportunities underway with DOH/CMS/GWTG

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Our StoryOur Story

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Our organization was founded in 1924 by six cardiologists who came together to share research

and promote further study of heart disease.

Since then, we’ve grown to be the largest voluntary organization fighting heart disease/stroke in the

U.S. with 22.5 million donors and volunteers who help direct more than $500 million each year to our research for effective prevention and treatment of

CVD and stroke.

Together, we have made life longer and stronger. Our work has funded the work of eight Nobel

Laureates and spurred revolutionary innovations such as bypass surgery, CPR and the pace-maker…

Together AHATogether AHA and and ASA ASA

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Reduce disability and death from heart disease and stroke- Fighting #1 and #3 killers of adults across all demographics and economic backgrounds

- Strategic driving force to provide credible, effective prevention/treatment information

Decrease heart disease, stroke and risk by 25% by 2010 - Strategy: To improve the quality of CVD outcomes for patients

Largest voluntary organization fighting heart disease/stroke in the U.S.- 12 affiliates and 2200 divisions across the country

- Professional membership of 13 scientific councils, three interdisciplinary working groups

- Trusted source for hospitals and healthcare providers across the country

Invest $400 million dollars in research, education and awareness annually- Latest guidelines, journals, conferences, seminars and educational information provided

OrganizationalOrganizationalMission Mission

GrassrootsGrassrootsReach Reach

Groundbreaking Groundbreaking Research Research

ImpactImpactGoal Goal

Heart Disease Heart Disease and and Stroke TodayStroke Today

Cardiovascular diseases (CVD) accounted for 38% of deaths in the U.S. in 2002Cardiovascular diseases (CVD) accounted for 38% of deaths in the U.S. in 2002

32% of these deaths from CVD occurred prematurely32% of these deaths from CVD occurred prematurely

Heart attack survivors have 1.5-15 times greater risk of illness/death post-event Heart attack survivors have 1.5-15 times greater risk of illness/death post-event

In 2005, the estimated direct and indirect cost of CVD is $393.5 billion In 2005, the estimated direct and indirect cost of CVD is $393.5 billion

More than 70 million Americans have one or more types of cardiovascular disease…AHA and ASA, along with our strategic alliance partners and donors, work every day to lessen the human and financial

toll of these chronic diseases.

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*American Heart Association, Statistical Update, 2005

More than half of all heart disease and stroke patients do not receive consistent preventive instructions

upon discharge from the hospital…

Heart Heart andand Stroke Patient Treatment Stroke Patient Treatment

66%66% of heart failure patients of heart failure patients were discharged without four were discharged without four proven prevention therapies proven prevention therapies

68%68% of patients who smoked of patients who smoked were not advised to quit were not advised to quit

33%33% of “ideal” candidates were of “ideal” candidates were not treated with ACE Inhibitorsnot treated with ACE Inhibitors

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*The Wall Street Journal, November 9, 2003, Physicians’ Weekly, June 21, 2004, ADHERE Study

Challenging Challenging RealityReality

Discharge protocols

Written discharge

instructions

Risk modification

counseling

Appropriate

prescriptions

Proven, evidence-based preventive guidelines are known and available, and should be part of every hospital’s routine…

…but sadly, this is not always the case.

“We now have a situation where medicine is by

memory. Busy clinicians try to recall for each

complex patient the appropriate evidence-based

therapies, all during the chaos of the day.

If they don't remember all of this…

there are repetitive oversights.” Gregg Fonarow, MD, FACC, FACP UCLA Division of Cardiology

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Gaps Gaps in in OverallOverall Quality Quality ofof Care Care

Tens of thousands of patients die each year due to preventable healthcare errors

More people die annually from medical errors than from AIDS or breast cancer

It takes an average of 17 years for new knowledge to be incorporated into practice

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*Institute of Medicine, Shaping the Future for Health, 2001 and To Err is Human, 1999

“Healthcare harms patients too frequently and routinely fails to deliver its potential benefits. Between the healthcare that we now have

and the healthcare that we could have lies not just a gap, but a chasm.”

Devastating Devastating ResultsResults

40%40% of heart disease or stroke of heart disease or stroke patients will have a repeat eventpatients will have a repeat event

38%38% of women andof women and 25%25% of of men will die within a year of a men will die within a year of a heart attackheart attack

25%25% of men andof men and 22%22% of of women will die within a year women will die within a year of a strokeof a stroke

46%46% of women and of women and 22%22% of of men will be disabledmen will be disabled

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*Physicians’ Weekly, American Heart Association Statistical Update

“Patients go to hospitals, and half the time are being discharged without the complete group of therapies that have been absolutely proven to prolong their life, and there is no reason other than the medical system just isn’t working that well.”

Opportunity Opportunity forfor Hope Hope

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Experts suggest that mortality rates after acute coronary syndromes could be Experts suggest that mortality rates after acute coronary syndromes could be reduced by up to 80% just by properly instituting the knowledge and guidelines reduced by up to 80% just by properly instituting the knowledge and guidelines

already proven.already proven.

“There’s little disagreement on the value of making up these treatment gaps. We

need to break the gaps and recognize the tremendous barrier in outpatient care to

effectively implement and retain important therapies…to save more lives.”

Gregg Fonarow, MD*Circulation, February 17, 2004, Physicians’ Weekly, June 21, 2004

Introducing Introducing thethe Solution Solution

“Get With The GuidelinesSM is a model for the nation in addressing a dire

health-care issue. The program helps patients, working with caregivers, learn how to take action to

save their own lives.”  - Tommy Thompson, Secretary of HHS

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The The American Heart AssociationAmerican Heart Association has developed an has developed an unprecedented method to close this treatment gapunprecedented method to close this treatment gap

Derived directly from evidence-based guidelines, the program provides tools and Derived directly from evidence-based guidelines, the program provides tools and resources designed to help hospitals dramatically reduce patients’ risk resources designed to help hospitals dramatically reduce patients’ risk

of recurrent cardiovascular eventsof recurrent cardiovascular events

ProvenProven Results Results

Scandinavian Simvastatin Survival Study (4S)

Decrease in recurrent events/mortality:34% risk reduction for recurrent events 42% risk reduction in CVD mortality

Brown University StudyBrown University Study

Improvement in preventive treatments:89% given aspirin, up from 75%

85% given Beta-Blockers, up from 62%

UCLA CHAMP Study

Decrease in recurrent events/mortality:Decrease in recurrent events/mortality:Risk down to Risk down to 6.4%6.4% from from 14.8%14.8%

Improvement in preventive treatments:Improvement in preventive treatments:use of Statins up to use of Statins up to 86%86% from from 6%6%

use of Beta-Blockers up to use of Beta-Blockers up to 61%61% from from 12%12%use of ACE Inhibitors up to use of ACE Inhibitors up to 56%56% from from 4%4%

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New England Pilot ProgramNew England Pilot Program Improvement in

preventative treatments: 86% smoking cessation,

up from 48%88% lipid treatment,

up from 54%74% rehabilitation referral,

up from 34%

1. Incorporate latest proven research and knowledge of leading industry groups

2. Utilize “teachable moment” prior to patient discharge

3. Take a multi-disciplinary team approach

4. Develop and empower leaders to change culture of quality within hospitals

5. Provide ability for measurement via Web-based clinical decision support tool

6. Provide hospitals with consistent patient-discharge protocols

7. Offer customized patient materials

8. Encourage provider-to-provider communications

9. Recognize 85% compliant hospitals as performance leaders

10. Improve patient quality of life and reduce risk

ProgramProgram Strategy Strategy

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How How It It WorksWorksThe process-improvement and overall culture of change that is prompted by Get

With The GuidelinesSM automatically drives increased patient safety

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Proven Risk Reduction Therapies:- Lipid lowering therapy

- ACE Inhibitor/ARB use

- Beta-Blocker use

-Aspirin or other Antithrombotic medication

-t-PA

Pre-discharge Counseling: - Smoking cessation

- Weight and exercise management

- Insulin control

- Alcohol and drug abuse management

Post-treatment Referrals: - Cardiac Rehabilitation

Guidelines Guidelines forfor Treatment and Treatment and Prevention Prevention

Adherence to these treatment guidelines reduces risk of death and/or recurrent events by up

to 40% in patients

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*American Heart Association

AHA SupportAHA Support and and Resources Resources

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Easy Implementation

Hospitals ReapHospitals Reap the the Benefits Benefits

Improved Outcomes

Improved Care

““We did calculations based upon how well we were We did calculations based upon how well we were performing before we initiated this program and performing before we initiated this program and

realized that we were going to be able to save lives or realized that we were going to be able to save lives or prevent second heart attacks.”prevent second heart attacks.”

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““With systems in place to get things done, I don’t have to With systems in place to get things done, I don’t have to change one physician’s behavior at a time, but I give them a change one physician’s behavior at a time, but I give them a

system and framework in which to practice that’s quite easy to system and framework in which to practice that’s quite easy to implement.”implement.”

““As a cardiologist…I’m convinced it is improving the care of As a cardiologist…I’m convinced it is improving the care of my patients. As an AHA volunteer, I’m equally convinced it’s my patients. As an AHA volunteer, I’m equally convinced it’s

critical to improving the quality of care for patients critical to improving the quality of care for patients nationwide.”nationwide.”

- Karol Watson, MD, UCLA Medical Center- Karol Watson, MD, UCLA Medical Center

- Robert O. Bonow, MD, 2002-2003 AHA President - Robert O. Bonow, MD, 2002-2003 AHA President

- Gray Ellrodt, MD, Berkshire Medical Center- Gray Ellrodt, MD, Berkshire Medical Center

Hospitals ReapHospitals Reap the the Benefits, cont’d Benefits, cont’d

Cost Savings

Increased Communications

““We began to realize we were actually reducing the We began to realize we were actually reducing the amount of time documenting--by imbedding the guidelines amount of time documenting--by imbedding the guidelines

into order sets and discharge sheets, it decreased the into order sets and discharge sheets, it decreased the amount of time to write orders and on follow-up phone amount of time to write orders and on follow-up phone

calls regarding clarification of contraindications.”calls regarding clarification of contraindications.”

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““What started as a program to help patients, helped our staff What started as a program to help patients, helped our staff too. Our collective brainstorming sessions gave us an too. Our collective brainstorming sessions gave us an opportunity to be part of a creative, team experience toward opportunity to be part of a creative, team experience toward a positive goal.a positive goal.””

- Gregg Fonarow, MD, UCLA Cardiomyopathy Center

- Mary Jensen, RN, Presbyterian/St. Luke’s Hospital

Peace Peace of of Mind Mind forfor Patients Patients and and their their Loved Loved OnesOnes

Improved Communication With Healthcare ProvidersIncreased coordination between hospital and referring physiciansImproved Communication With Healthcare ProvidersIncreased coordination between hospital and referring physicians

Higher Quality of CareConsistent, comprehensive, proven treatment methods

Higher Quality of CareConsistent, comprehensive, proven treatment methods

Customized Education InformationShort and long-term prevention strategies are based on patient’s specific risk

profile

Customized Education InformationShort and long-term prevention strategies are based on patient’s specific risk

profile

Up-to-date Prevention StrategiesNew techniques are made available through easy-to-understand tools

Up-to-date Prevention StrategiesNew techniques are made available through easy-to-understand tools

Decreased risk of death or recurrent related health problems

“Patients have a 10-to-15 fold higher likelihood of adhering to recommended prevention therapy when it is started in the hospital.”

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*Physicians’ Weekly, June 21, 2004

ProofProof Points Points

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Hospitals have shown “across the board improvement” in quality of care provided to patients through the Get With The GuidelinesSM

initiative.- Kenneth A. LaBresh, Brown University

• > 1000 hospitals currently participate in the program, improving the care of 660,000 patients

• Since its inception in 2001, Get With The GuidelinesSM

has grown to three modules

• Several studies among Get With The GuidelinesSM

hospitals across the country have shown:

– Adherence to all ten measures were enhanced in year one for GWTG-CAD

– Racial and ethnic treatment disparities were narrowed or eliminated in 83% of measures

– Gender-related treatment gaps were narrowed or eliminated in four of five measures

– An average of 20% improvement in eight measures for GWTG-Stroke in one year*The Wall Street Journal, November 9, 2003, Abstracts from AHA’s Scientific Sessions, 2004, Abstracts from ASA’s International Stroke Conference 2005

Collaborative Opportunities Collaborative Opportunities UnderwayUnderway

• New Mexico Department of Health funding ~funding for 5 GWTG Stroke modules placed by July 06

• Funding from State Legislature

• Colorado State Stroke Registry ~ funding for 26 hospitals to participate in GWTG Stroke by July 07

• Amendment 35 Funding

• Colorado Foundation for Medical Care “Get With the Guidelines” Grant – funding for 34 modules (CAD and/or HF) to be placed by July 07

• Amendment 35 Funding

OurOur Future Future PlansPlans

Position AHA/ASA guidelines as the Position AHA/ASA guidelines as the preferred standardpreferred standard of care of care

Increase implementation to Increase implementation to 1,800 hospitals1,800 hospitals across the country by the end of 2008 across the country by the end of 2008

Obtain Obtain 85% compliance by hospitals85% compliance by hospitals on the Get With The Guidelines on the Get With The GuidelinesSMSM

indicators indicators

Leverage researchLeverage research to further enhance quality of care by gathering current best to further enhance quality of care by gathering current best practicespractices

Champion the issue of health information technology and Champion the issue of health information technology and integrate hospital integrate hospital electronic systemselectronic systems

Explore potential to create new custom modules for more deadly, debilitating Explore potential to create new custom modules for more deadly, debilitating disease statesdisease states

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With your generous and much needed support in the coming years, we will continue to work toward attaining our lofty objectives:

AppendixAppendix

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• ““In-Hospital Initiation of Guideline-Recommended Therapies and Patient Education Improves Treatment Rates, In-Hospital Initiation of Guideline-Recommended Therapies and Patient Education Improves Treatment Rates, Long-Term Adherence, and Clinical Outcomes” Long-Term Adherence, and Clinical Outcomes” Physician’s Weekly, Physician’s Weekly, June 21, 2004June 21, 2004

• ““Heart Patients More Likely to Live When Recommended Medicines Used in Combination” Heart Patients More Likely to Live When Recommended Medicines Used in Combination” Circulation: Circulation: Journal of the American Heart AssociationJournal of the American Heart Association , February 17, 2004, February 17, 2004

• ““More Kentucky Hospitals Following Heart Disease Prevention Program Guidelines” Kentucky Department of More Kentucky Hospitals Following Heart Disease Prevention Program Guidelines” Kentucky Department of Health, January 2004Health, January 2004

• December 2003December 2003 Media Coverage Summary of Get With The GuidelinesMedia Coverage Summary of Get With The GuidelinesSMSM

• November 2003 Media Coverage Summary of Get With The GuidelinesNovember 2003 Media Coverage Summary of Get With The GuidelinesSMSM

• ““Heart Studies Cite Treatment Gaps” Heart Studies Cite Treatment Gaps” Wall Street Journal, Wall Street Journal, November 9, 2003November 9, 2003• Cardiovascular Watch Cardiovascular Watch Newsletter, May 21, 2004Newsletter, May 21, 2004

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Studies and ReportsStudies and Reports

ArticlesArticles

• ““Crossing the Quality Chasm: A New Health System for the 21st Century” Institute of Medicine, March 2001Crossing the Quality Chasm: A New Health System for the 21st Century” Institute of Medicine, March 2001• ““To Err is Human” Institute of Medicine, 1999To Err is Human” Institute of Medicine, 1999• ““Cardiac Program Unites Staff at Denver Hospital,” Sidebar – Presbyterian/St. Luke’s Success, Mary Jensen, Cardiac Program Unites Staff at Denver Hospital,” Sidebar – Presbyterian/St. Luke’s Success, Mary Jensen,

RN, Kind Hearts and Helping HandsRN, Kind Hearts and Helping Hands

Research ReviewResearch Review

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Press ReleasesPress Releases

• ““American Heart Association's Hospital-based Quality Improvement Program Receives Award From Health American Heart Association's Hospital-based Quality Improvement Program Receives Award From Health and Human Service Secretary Tommy Thompson” American Heart Association, December 13, 2004 and Human Service Secretary Tommy Thompson” American Heart Association, December 13, 2004 

• ““Hospitals That Follow Heart Attack Guidelines Have Lower In-Hospital Death Rates” American Heart Hospitals That Follow Heart Attack Guidelines Have Lower In-Hospital Death Rates” American Heart Association, November 17, 2002Association, November 17, 2002

• ““Hospitals That Follow Guidelines May Reap Rewards” American Heart Association, October 13, 2002Hospitals That Follow Guidelines May Reap Rewards” American Heart Association, October 13, 2002• ““American Heart Association Encourages Acute Care Hospitals to Get With The GuidelinesAmerican Heart Association Encourages Acute Care Hospitals to Get With The Guidelines

SMSM

” American Heart ” American Heart Association, August 2002Association, August 2002

• ““American Heart Association Healthcare Quality Improvement Program Recognized by U.S. Health and American Heart Association Healthcare Quality Improvement Program Recognized by U.S. Health and Human Services” American Heart Association, February 28, 2002Human Services” American Heart Association, February 28, 2002

• ““Heart Treatment Gap Closes With Standardized Care” American Heart Association, October 2001Heart Treatment Gap Closes With Standardized Care” American Heart Association, October 2001

Research ReviewResearch Review