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Quality Improvement Programs and Critical Pathways

Quality Improvement Programs and Critical Pathways. 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.”

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Quality Improvement Programs and Critical Pathways

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  1. Quality Improvement Programs and Critical Pathways

  2. 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, MDDirector, Center for Cardiovascular Science and Medicine, UNC School of Medicine

  3. Critical Pathways • 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.

  4. Joint Commission on Accreditationof Healthcare Organizations (JCAHO) • 1997: Launched ORYX™ to integrate use of outcomes and other performance measures into accreditation process • 2001: Announced 4 initial core measurement areas for hospitals (2 of 4 required): • Acute MI • Heart failure • Community-acquired pneumonia • Pregnancy • 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

  5. JCAHO Quality Measures in MI Hospitals graded on: • Antiplatelet therapy in AMI at arrival and discharge • b-blocker therapy at arrival and discharge • ACE inhibitor therapy for LVSD • Time to thrombolysis • Time to PCI • Adult smoking cessation counseling • Inpatient mortality www.jcaho.org

  6. Why a Hospital-Based System? • Patients • Patient capture point • Have patients/family attention: “teachable moment” • Predictor of care in community • Hospital structure • Standardized processes/protocols/orders/teams • JCAHO (ORYX and “Shared Visions – New Pathways”) Source: http://www.americanheart.org/getwiththeguidelines

  7. Practical Steps to Improve the Use of Evidence-Based Therapies for ACS • Develop critical pathways • Establish a multidisciplinary team approach (cardiology, ED, primary care, nursing, laboratory) • Identify local cardiology and ED “champions” • Track adherence to ACC/AHA guidelines • Develop educational materials to improve physicians’ knowledge of the guidelines • Secure institution’s commitment to improved patient care • Identify areas for continuous QI; provide QI tools • Elicit ongoing quarterly feedback Cannon CP, et al. Am Heart J. 2002;143:777-789.

  8. EMS Discharge Inpatient Critical Pathways Begin in Ambulance and Extend to Long-term, Office-based Care ED Community 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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