The University of Michigan applies real-time monitoring to American College of Cardiology’s Guidelines Applied in Practice project (GAP project)
Combination of GAP guidelines and real-time implementation leads to higher use of evidence-based therapies and better outcomes
Background
For many years, a large gap has existed between the American College of Cardiology’s national heart attack treatment guidelines and the care that patients actually receive in hospitals across the country. In 2002, a team of hospitals in Southeast Michigan, led by the University of Michigan, reported great success in improving the odds that patients will get the medicines, tests, procedures, counseling and follow-up care that are proven to improve their chances of surviving a heart attack and returning to a full life. The team initiated the American College of Cardiology Guidelines Applied in Practice Initiative project – referred to as GAP.
Beginning July 1, 2002, researchers from the University of Michigan Health System and Loyola University took GAP a step further by conducting real-time monitoring of the GAP model at the University of Michigan Health System (Vasaiwala, 2007). Inpatient Leadership Team nurses surveyed all admissions that had the potential for diagnosis as an acute coronary syndrome, and ensured that clinicians consistently used GAP tools.
Data
The study involved 3,189 patients:
- 2,019 from the baseline period (preintervention)
- 1,170 from the remeasurement (postintervention) period when real-time monitoring was taking place
Most clinical characteristics of the patients were similar.
Therapy and Outcome In-Hospital and Follow-up:
Results
The combination of American College of Cardiology’s GAP program and its real-time implementation leads to higher use of evidence-based therapies and correspondingly better outcomes than those associated with the initial GAP implementation.
Real-time GAP implementation correlated with:
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More frequent use of in-hospital angiotensin-converting enzyme inhibitors, beta blockers, statins, other antiplatelet agents including clopidogrel and ticlopidine, and glycoprotein IIb/IIIa inhibitors
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Fewer episodes of in-hospital congestive heart failure and major bleeding events
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Higher discharge rates of aspirin, beta blockers, statins and angiotensin-converting enzyme inhibitors
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Fewer rehospitalizations for heart disease, myocardial infarction and combined death/cerebrovascular accident/myocardial infarctions during the first six months after discharge
What This Means for Patients
By applying real-time monitoring to GAP policy and procedures, the University of Michigan Health System – a recognized leader in health care – continues to demonstrate that applying the GAP process in patient care results in continuous and consistent high performance across all cardiac measures of quality.
For More Information
For details about the Guidelines Applied in Practice study, contact Kim Eagle, M.D., director, U-M Cardiovascular Center at 734-936-5275, or see the article, “Improving Quality of Care for Acute Myocardial Infarction: The Guidelines Applied in Practice (GAP) Initiative,” Journal of the American Medical Association, Vol. 287, No. 10, March 13, 2002. (PDF)
To learn more about how the University of Michigan is committed to quality and appropriateness, contact John E. Billi, M.D., associate dean for Clinical Affairs, University of Michigan Medical School, at 734-936-5214, or Darrell Campbell Jr., M.D., chief of staff, University of Michigan Hospitals and Health Centers, at 734-936-5814.
Posted August 2007
