Transcript STRIVE Lecture 1 - Clinical Trial Results

Quality Improvement
Programs and
Critical Pathways
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Why Develop Critical Pathways?
“A treatment gap between therapy that is
dictated by evidence-based medicine and
therapy that occurs in practice is not a deficit
of knowledge; rather, it is a deficit of
implementation.”
Sidney Smith, MD
Director, Center for Cardiovascular Science
and Medicine, UNC School of Medicine
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Critical Pathways
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Standardized treatment protocols for the management of
specific disorders
Developed to optimize and streamline patient care
Prevent underutilization of medications, time in
ICU/hospital, costs
Ensure quality-of-care measures (eg, door-to-drug times)
Optimize patient triage
Facilitate communication with specialists and PCP
post-discharge
Enhance patient compliance and outcomes
Minimize potential for medical errors
Improve compliance with national standards (JCAHO)
Adapted from: Cannon CP, O’Gara PT. Critical Pathways in Cardiology.
Lippincott Williams & Wilkins; 2001.
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Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)
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1997: Launched ORYX™ to integrate use of outcomes and
other performance measures into accreditation process
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2001: Announced 4 initial core measurement areas for
hospitals (2 of 4 required):
– Acute MI
– Heart failure
– Community-acquired pneumonia
– Pregnancy
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2004: New accreditation process (“Shared Visions–New
Pathways”) introduced. Hospitals previously collecting 2 of 4
measure sets are now required to collect 3 of 4 measure sets
www.jcaho.org
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JCAHO Quality Measures in MI
Hospitals graded on:
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Antiplatelet therapy in AMI at arrival and discharge
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b-blocker therapy at arrival and discharge
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ACE inhibitor therapy for LVSD
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Time to thrombolysis
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Time to PCI
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Adult smoking cessation counseling
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Inpatient mortality
www.jcaho.org
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Why a Hospital-Based System?
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Patients
– Patient capture point
– Have patients/family attention:
“teachable moment”
– Predictor of care in community
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Hospital structure
– Standardized
processes/protocols/orders/teams
– JCAHO (ORYX and “Shared Visions –
New Pathways”)
Source: http://www.americanheart.org/getwiththeguidelines
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Practical Steps to Improve the Use of
Evidence-Based Therapies for ACS
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Develop critical pathways
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Establish a multidisciplinary team approach (cardiology,
ED, primary care, nursing, laboratory)
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Identify local cardiology and ED “champions”
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Track adherence to ACC/AHA guidelines
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Develop educational materials to improve physicians’
knowledge of the guidelines
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Secure institution’s commitment to improved patient care
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Identify areas for continuous QI; provide QI tools
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Elicit ongoing quarterly feedback
Cannon CP, et al. Am Heart J. 2002;143:777-789.
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Critical Pathways Begin in Ambulance and
Extend to Long-term, Office-based Care
EMS
ED
Community
Inpatient
Discharge
Adapted from Cannon CP, O’Gara PT. Critical Pathways in Cardiology.
Lippincott Williams & Wilkins; 2001.
Corbelli J, et al. Critical Pathways in Cardiology. 2003;2:71-87.
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