Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
Am Heart J. 2010 Feb;159(2):207-14. doi: 10.1016/j.ahj.2009.11.002.
Previous reports have demonstrated that participation in GWTG-CAD, a national quality initiative of the American Heart Association, is associated with improved guideline adherence for patients hospitalized with CAD. We sought to establish whether these benefits from participation in GWTG-CAD were sustained over time.
We used the Centers for Medicare and Medicaid Services Hospital Compare database to examine 6 performance measures and one composite score for 3 consecutive 12-month periods including aspirin and beta-blocker on arrival/discharge, angiotensin-converting enzyme inhibitor (ACE-I) for left ventricular systolic dysfunction (LVSD), and adult smoking cessation counseling. The differences in guideline adherence between the GWTG-CAD hospitals (n = 440, 439, 429) and non-GWTG-CAD hospitals (n = 2,438, 2,268, 2,140) were evaluated for each 12-month period. A multivariate mixed-effects model was used to estimate the independent effect of GWTG-CAD over time adjusting for hospital characteristics.
Compared with non-GWTG hospitals, the GWTG-CAD hospitals demonstrated higher guideline adherence for 6 performance measures. The largest differences existed for (1) aspirin at arrival (2.3%, 2.1%, and 1.6% for each 12-month period, respectively), (2) aspirin at discharge (3.4%, 2.2%, and 2.3%), (3) beta-blocker at arrival (3.4%, 2.9%, and 2.6%), and (4) beta-blocker at discharge (2.8%, 1.8%, and 1.5%). In multivariate analysis, the GWTG-CAD hospitals were independently associated with better adherence for 4 of the 6 measures (the exceptions were ACE-I for LVSD and smoking cessation counseling). Superior performance was also found for the composite measures. Although there was some narrowing between groups, GWTG-CAD hospitals maintained superior guideline adherence than non-GWTG-CAD hospitals for the entire 3-year period (adjusted differences 1.8%, 1.6%, and 1.4%).
Hospitals participating in GWTG-CAD had modestly superior acute cardiac care and secondary prevention measures performance relative to non-GWTG-CAD. These benefits of GWTG-CAD participation were sustained over time and independent of hospital characteristics.
先前的报告表明，参与美国心脏协会的国家质量倡议 GWTG-CAD 与 CAD 住院患者的指南依从性提高有关。我们试图确定从 GWTG-CAD 参与中获得的这些益处是否随着时间的推移而持续存在。
我们使用医疗保险和医疗补助服务中心的医院比较数据库，检查了 6 项绩效指标和一个综合评分，这些指标涵盖了连续三个 12 个月的时间段，包括到达/出院时的阿司匹林和β受体阻滞剂、左心室收缩功能障碍（LVSD）的血管紧张素转换酶抑制剂（ACE-I）和成人戒烟咨询。评估了 GWTG-CAD 医院（n=440、439、429）和非 GWTG-CAD 医院（n=2438、2268、2140）在每个 12 个月期间的指南依从性差异。使用多变量混合效应模型来估计 GWTG-CAD 随着时间的推移的独立影响，同时调整了医院特征。
与非 GWTG 医院相比，GWTG-CAD 医院在 6 项绩效指标上的指南依从性更高。最大的差异存在于：（1）到达时的阿司匹林（分别为每个 12 个月期间的 2.3%、2.1%和 1.6%）、（2）出院时的阿司匹林（3.4%、2.2%和 2.3%）、（3）到达时的β受体阻滞剂（3.4%、2.9%和 2.6%）和（4）出院时的β受体阻滞剂（2.8%、1.8%和 1.5%）。在多变量分析中，GWTG-CAD 医院与 6 项措施中的 4 项（LVSD 的 ACE-I 和戒烟咨询除外）的更好的依从性独立相关。综合措施也显示出更好的性能。尽管两组之间的差距有所缩小，但 GWTG-CAD 医院在整个 3 年期间仍保持优于非 GWTG-CAD 医院的指南依从性（调整后的差异为 1.8%、1.6%和 1.4%）。
与非 GWTG-CAD 医院相比，参与 GWTG-CAD 的医院在急性心脏护理和二级预防措施方面的表现略有优势。GWTG-CAD 参与的这些益处随着时间的推移而持续存在，并且独立于医院特征。
