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Primer: implementation of guideline-based programs for coronary care

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 163–171 (2006)Cite this article

Abstract

The American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice program in Michigan, USA, was an initiative designed to improve the quality of cardiovascular care by bringing the American College of Cardiology/American Heart Association practice guidelines to the point of care. The program consisted of three different projects, involving a total of 33 hospitals. The program was implemented in five phases—planning, tool implementation, monitoring of tool use, remeasurement and reporting of results—by use of a collaborative model, which included a series of learning sessions for staff members that focused on the five phases. The goal was to identify the highest care priorities for patients with acute coronary syndromes and to incorporate these into the care itself. This aim was achieved with a standardized set of clinical-care tools, such as admission orders and discharge contracts; the use of such tools is associated with improvement in adherence to guidelines. Strategies were, however, tailored to each hospital by local teams. Performance was assessed by the use of tracking tools, which facilitate rapid improvement by enabling key performance indicators founded on the guidelines to be monitored. Using qualitative surveys of the project leaders, we identified an optimum timeline and correlations between hospital-specific attributes and greater or lesser success in achieving positive change. In this review, we describe our experience and identify the most useful strategies for future implementation of such a project.

Key Points

  • The American College of Cardiology/American Heart Association guidelines are founded on the results of randomized trials that prove certain therapies will reduce morbidity and mortality in patients with myocardial infarction

  • When standardized tools are used by the care providers, the probability that the guidelines will be applied consistently is increased

  • When the standardized tools from the GAP AMI tool kit are used, the frequency of use of guideline-recommended therapy is significantly raised

  • When standardized tools from the GAP AMI tool kit are used, in-hospital mortality and mortality at 30 days and 1 year after discharge fall significantly

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Figure 1: Collaborative model for the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice program implemented over 12 months.

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Authors and Affiliations

  1. Cardiovascular Center,

    Kim A Eagle, Todd M Koelling & Cecelia K Montoye

  2. Cardiovascular Division, Heart Failure Program, University of Michigan Health System,

    Kim A Eagle, Todd M Koelling & Cecelia K Montoye

  3. Michigan Heart and Vascular Institute, St Joseph Mercy Hospital, Ann Arbor, MI, USA

    Kim A Eagle, Todd M Koelling & Cecelia K Montoye

Authors
  1. Kim A Eagle
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  2. Todd M Koelling
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  3. Cecelia K Montoye
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Correspondence to Kim A Eagle.

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The authors declare no competing financial interests.

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Eagle, K., Koelling, T. & Montoye, C. Primer: implementation of guideline-based programs for coronary care. Nat Rev Cardiol 3, 163–171 (2006). https://doi.org/10.1038/ncpcardio0499

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