Achieving better in-hospital and after-hospital care of patients with acute cardiac disease

Scott, I. A., Denaro, C. P., Bennett, C. J., Hickey, A. C., Mudge, A. M., Flores, J. L., Sanders, D. C. J., Thiele, J. M., Wenck, B., Bennett, J. W. and Jones, M. A. (2004) Achieving better in-hospital and after-hospital care of patients with acute cardiac disease. Medical Journal of Australia, 180 10; Suppl.: S83-S88.

Author Scott, I. A.
Denaro, C. P.
Bennett, C. J.
Hickey, A. C.
Mudge, A. M.
Flores, J. L.
Sanders, D. C. J.
Thiele, J. M.
Wenck, B.
Bennett, J. W.
Jones, M. A.
Title Achieving better in-hospital and after-hospital care of patients with acute cardiac disease
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 0025-729X
Publication date 2004
Sub-type Article (original research)
Volume 180
Issue 10; Suppl.
Start page S83
End page S88
Total pages 6
Place of publication Australia
Publisher Australasian Medical Publishing Company
Collection year 2004
Language eng
Subject C1
321208 Primary Health Care
730299 Public health not elsewhere classified
11 Medical and Health Sciences
Abstract In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF. Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P=0.06) and from 13.4% to 10.1% (P= 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P= 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes.
Keyword Medicine, General & Internal
Quality Improvement
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2005 Higher Education Research Data Collection
School of Medicine Publications
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Created: Wed, 15 Aug 2007, 03:28:17 EST