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.
From the *Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX; †Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC; ‡RTI International, Waltham, MA; §Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; ¶Department of Medicine, UCLA Medical Center, Los Angeles, CA; and ∥Medicine, Berkshire Medical Center, Pittsfield, MA.
Reprints: Kim K. Birtcher, MS, PharmD, University of Houston College of Pharmacy, 1441 Moursund, Houston, Texas 77030. E-mail: firstname.lastname@example.org.