Abstract 3470: Successful Clinical Guidelines Implementation in a Large Integrated Healthcare System
Background: Despite the development of evidence-based clinical practice guidelines (CPG) for the management of acute coronary syndromes (ACS), implementation has been inconsistent across the U.S., leading to missed opportunities to decrease mortality. Kaiser Permanente Northern California (KPNC) has 3.2 million members. In the 90s, KPNC initiated systematic guideline implementation at 19 med centers.
Objective: (1) To develop multidisciplinary methods for the implementation of CPG for the management of ACS across a large healthcare system; (2) To examine the effectiveness of CPG implementation in 2006 by measuring adherence to 6 key interventions demonstrated to decrease ACS mortality.
Methods: ACS guidelines were developed by cardiologists and emergency physicians. Local leaders disseminated the guidelines at each med center. Standardized admit and discharge orders for hospitalized pts were implemented at each medical center by 4 departments working closely together: cardiology, quality, emergency medicine, and hospital-based specialists. KPNC data were compared to NRMI data for 150,645 pts from 10/00 –9/01.
Results: In the 4th quarter of 2006, we admitted 598 pts with ACS through emergency departments (ED) at 19 medical centers. Data were collected by individual chart review on 2 interventions that were expected to occur in the ED and 4 expected at discharge. Of 598 pts confirmed with ACS, > 99% received aspirin. Of 539 eligible pts 97% received beta blockers in the ED. This is compared with 91% and 74% in the national NRMI database. At discharge, 98% of 485 eligible pts received aspirin vs. 85% in NRMI; 98% of 524 eligible pts received beta blockers vs 78% in NRMI; 92% of 91 eligible pts received an ACE inhibitor or ARB vs 55% in NRMI; and of 97% of 99 smokers received instructions on smoking cessation vs.40% in NRMI. Since 1995 CHD deaths in KPNC have declined yearly.
Conclusions: Collaboration among diverse depts involved in the care of ACS pts in a large integrated health care system has resulted in effective implementation of evidence-based guidelines and declining cardiovascular mortality. If these results could be duplicated nationwide,more than 22000 lives could be saved annually.