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Pilot Results

Kenneth A. LaBresh, MD; A. Gray Ellrodt, MD; Richard Gliklich, MD; James Liljestrand, MD; Randolph Peto, MD

Arch Intern Med. 2004;164:203-209.

Background  The use of Web-based technology and a collaborative model to improve hospital adherence to secondary prevention guidelines has not been previously evaluated.

Methods  Twenty-four hospitals in Massachusetts participated in a collaborative that met quarterly, with didactic and best-practice presentations and interactive multidisciplinary team workshops. A customized tool kit and interactive, Web-based management tool were used for data collection and on-line feedback. Data from 1738 patients admitted with coronary artery disease were collected by hospital staff from July 1, 2000, to June 30, 2001. Outcome measures included differences between baseline and 10- to 12-month follow-up measurements of use of aspirin, -blockers, angiotensin-converting enzyme inhibitors, cholesterol measurement and treatment, smoking cessation counseling, blood pressure control, and cardiac rehabilitation referral.

Results  Clinically and statistically significant increases from baseline to 10- to 12-month follow-up were demonstrated in smoking cessation counseling (48% [95% confidence interval {CI}, 36.6%-58.4%] to 87% [95% CI, 73.1%-100.7%]), lipid treatment (54% [95% CI, 46.6%-70.2%] to 79% [95% CI, 70.2%-88.3%]), lipid measurement (59% [95% CI, 51.5%-66.0%] to 81% [95% CI, 72.0%-89.5%]), and cardiac rehabilitation referral (34% [95% CI, 25.9%-39.7%] to 73% [95% CI, 63.2%-82.9%]). An improving trend was seen in blood pressure control (60% [95% CI, 55.3%-65.6%] to 68% [95% CI, 60.2%-76.1%]). High baseline use was maintained for use of aspirin, -blockers, and angiotensin-converting enzyme inhibitors.

Conclusion  Implementation of a collaborative quality improvement initiative, interactive training of hospital teams with physician champions, and the use of an interactive Web-based Patient Management Tool enhanced adherence to prevention guidelines in hospitalized patients with coronary artery disease.

From the Department of Medicine, Brown University School of Medicine, Providence, RI (Dr LaBresh); Berkshire Medical Center, Pittsfield, Mass (Dr Ellrodt); Outcome Sciences Inc, Boston, Mass (Dr Gliklich); and MassPRO Inc, Waltham, Mass (Drs LaBresh, Liljestrand, and Peto). Dr Gliklich is president and CEO of Outcome Sciences, Inc, the vendor for the Web-based Patient Management Tool.

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