Partners
Michigan Chapter
of the ACC
MPRO, Quality
Improvement Organization for Michigan
Greater Detroit
Area Health Council
Greater Flint
Health Coalition
Project Setting
Hospitals
Project Features:
- Project Kick-off presentations
- Rapid-cycle
implementation
- Development and implementation of the AMI GAP Tool Kit
- Identification and utilization of nurse and physician opinion
leaders
- Kick-off and follow-up grand-rounds and site visits
- Pre- and post-intervention measurement of key performance
indicators
Project Update
AMI GAP project article recently published in JACC (Oct.
4, 2005) shows heart attack death rates dropped significantly
at hospitals that participated in a quality-improvement process
and increased the use of evidence-based therapies. See below
abstract from JACC.
JACC Abstract
Objective: To assess the impact
of the American College of Cardiology’s
GAP Project for AMI care on mortality in Medicare
patients treated in Michigan.
Design and Setting: The GAP project, encompassing 33 acute-care
hospitals in southeastern Michigan.
Background: The Guidelines
Applied in Practice (GAP) Project has been
shown to increase the use of evidence based
therapies in acute myocardial infarction (AMI)
patients. It is unknown if GAP can also reduce
mortality in AMI patients.
Methods: Using a before (n=1368)
and after GAP implementation (n=1489) cohort
study, 2857 Medicare patients with AMI were
studied to assess the independent influence
of the GAP program on mortality. Multivariate
models were developed to test the independent
impact of GAP after controlling for comorbidities
and clinical findings on in-hospital, 30-day,
and 1-year mortality.
Results: Average patient age
was 76 years, 48% were women, and 16% represented
non-white minorities. Comparing post-GAP mortality
to a pre-GAP baseline, mortality fell after
GAP for each interval studied: hospital 10.4%
vs. 13.6%; 30-day 16.7% vs. 21.6%; and one-year
33.2% vs. 38.3%; all p<0.02. After multivariate
adjustment, GAP was associated with a 21-26%
mortality reduction, particularly at 30-days
(odds ratio GAP to baseline 0.74; 95% CI 0.59-0.94
p= 0.012) and at 1-year (odds ratio 0.78; 95%
CI 0.64-0.95; p=0.013). The effect was greatest
in the patients for whom a standard discharge
tool was utilized (one-year mortality, odds
ratio 0.53; 95% CI 0.36-0.76; p=0.0006).
Conclusion: Imbedding guidelines
priorities into practice for treating acute
MI was associated with improved levels of quality
indicators and 30-day and 1-year mortality.
This benefit is most marked when patients are
cared for using standardized, evidence-based
clinical care tools.
AMI GAP Project Beginnings
The GAP AMI project
began at the University of Michigan Health System and then expanded
to five acute care hospitals in 2001 in the
Flint and Saginaw communities of Michigan.
Nineteen additional hospitals were added
in southeast Michigan in January 2002 for
a total of 33. Based on lessons learned, a new feature of the
Southeast Michigan Expansion was the ACC AMI Collaborative Model
of quality improvement. The Model offers support to project leaders
through learning sessions on project planning, implementation,
and monitoring of tool use.
JACC Supplement “An Organizational
Framework for AMI ACC-GAP Project” to
be published in November 2005
The
supplement
will
present
an
organizational
framework
for
spreading
the successful practices learned from the AMI GAP quality improvement
demonstration project. The recommendations presented are based
on the three ACC AMI GAP Projects and what was learned about
the impact of using standardized tools and how to successfully
implement an inpatient quality improvement project, and the impact
of creating a standardized care system for acute MI.
Published articles on AMI GAP are listed below.
Closing
the Gap between Science and Practice
Taking
the National Guideline for Care of Acture Myocardial
Infarction to the Bedside
A
Rapid Cycle Collabortive Model to Promote Guidelines
for Actute Myocardial Infarction
Improving
Quality of Care for Acute Myocardial Infarction
Enhancing
Quality of Care for Acute Myocardial Infarction
The college gratefully acknowledges the generous support of an
unrestricted educational grant from AstraZeneca for the AMI GAP
Project in Michigan. |
