Do Clinical Practice Guidelines Improve Outcomes?
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1 Do Clinical Practice Guidelines Improve Outcomes? Canadian Cardiovascular HArmonization of National Guidelines Endeavour James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Senior Medical Director, Cardiovascular Health and Stroke Strategic Clinical Network
2 Faculty/Presenter Disclosure Faculty: James A. Stone Relationships with commercial interests: Grants/Research Support: Sanofi Speakers Bureau/Honoraria: AMGEN, Sanofi, Consulting Fees: AMGEN, Boehringer-Ingelheim, Sanofi, Other: Alberta Health Services
3 Acknowledgements CCRN Dr. Milan Gupta All of you! National CPG Committee Memberships: 1. Canadian Diabetes Association 2013, Canadian Cardiac Rehabilitation Cardiac Rehabilitation (Past Chair Editions 1,2,and 3) 3. Canadian Hypertension Education Program (2000 to 2015) 4. C-CHANGE (Canadian Cardiovascular HArmonization of National Guidelines Endeavour) (Co-Chair) 5. CCS Dyslipidemia 2009, 2012, CCS Smoking Cessation CCS Committee on Chronic Stable Angina CCS Committee on Refractory Angina Physical Activity for Adults Physical Activity for Persons with Spinal Cord Dysfunction (Chair) 2011
4 Do Clinical Practice Guidelines Improve Outcomes?
5 Do Clinical Practice Guidelines Improve Outcomes?
6 (Ladies and) Gentlemen, we must, indeed, all hang together or, most assuredly, we will all hang separately. Benjamin Franklin
7 Do Clinical Practice Guidelines Change Outcomes?
8 Yes! Do Clinical Practice Guidelines Change Outcomes? Maybe? No!
9 Do Clinical Practice Guidelines Change Outcomes?
10 Do Clinical Practice Guidelines Change Outcomes? Ancient History
11 Do Clinical Practice Guidelines Change Outcomes?
12 Do Clinical Practice Guidelines Change Outcomes? Yes! Clinical Outcomes Maybe? Economic Outcomes No! Administrative Outcomes
13 Do Clinical Practice Guidelines Change Outcomes? Yes! Clinical Outcomes Maybe? Economic Outcomes No! Administrative Outcomes
14 Do Clinical Practice Guidelines Improve Outcomes?
15 Do Clinical Practice Guidelines Improve Outcomes?
16 Do Clinical Practice Guidelines Change Outcomes? Yes! - Clinical Outcomes Canadian Hypertension Education Program BUT ONLY 34.7% Pts with diabetes are controlled CHHS HSFO % 13% 21% 13.7 % 5.8 % 14.7 % 65.7% 22% Rx and Control Rx Uncontrolled Aware Not Treated Unaware DM 9 % Rx and Control Aware Not Treated Rx Not Controlled Unaware 16 Joffres MR, et al., Am J Hypertens 1997;10: Leenen FHH, et al., CMAJ 2008;178(11):1441-9
17 Do Clinical Practice Guidelines Change Outcomes? Yes! - Clinical Outcomes Canadian Hypertension Education Program Cardiovascular Events in Canada DEATH Campbell NJ et al. Hypertension 2009;53:
18 Conclusions The findings suggest that hospitals receiving performance achievement awards from the GWTG program had better process of care and risk adjusted 30-day mortality for heart failure and coronary artery disease. While hospital characteristics explained some of this reduction in mortality, improved process of care was also an important factor, particularly for acute myocardial infarction hospitalization. The study provides evidence that quality improvement programs that improve process of care for heart disease may also improve patient outcome. Heidenreich PA et al. Circulation 2009
19 From: The Importance of Consistent, High-Quality Acute Myocardial Infarction and Heart Failure Care: Results From the American Heart Association s Get With The Guidelines Program Association of Hospital Adherence to AMI and HF Measures Graph showing adherence with (top) overall in-hospital mortality, (middle) in-hospital mortality for AMI patients, and (bottom) in-hospital mortality for HF patients. OR = odds ratio; other abbreviations as in Figures 1 and 2. Date of download: 2/23/2016 J Am Coll Cardiol. 2011;58(6): doi: /j.jacc Copyright The American College of Cardiology. All rights reserved.
20 From: Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke Figure Legend: There were 5404 patients in the 0- to 90-minute time window, in the 91- to 180-minute segment, and 7920 in the 181- to 270-minute time window. SNF indicates skilled nursing facility. JAMA. 2013;309(23): doi: /jama Copyright 2016 American Medical Association. All rights reserved.
21 Performance measure conformity by hospital PAA recognition and PSC certification status. Gregg C. Fonarow et al. J Am Heart Assoc 2013;2:e Gregg C. Fonarow et al
22 Do Clinical Practice Guidelines Change Yes! - Clinical Outcomes Outcomes? Maybe? Economic Outcomes No! Administrative Outcomes
23 Do Clinical Practice Guidelines Change Outcomes?
24 Yes! - Clinical Outcomes Do Clinical Practice Guidelines Change Outcomes? Maybe - Economic Outcomes No! Administrative Outcomes
25 Do Clinical Practice Guidelines Change Outcomes? Yes! - Clinical Outcomes Maybe? -Economic Outcomes No! Administrative Outcomes
26 Do Clinical Practice Guidelines Change Outcomes? Yes! - Clinical Outcomes Maybe? -Economic Outcomes No!- Administrative Outcomes Not cost-containment Quality Increased Cost Quality Is An Attitude!
27 Summary
28 Do Clinical Practice Guidelines Change Outcomes? Summary
29 Do Clinical Practice Guidelines Change Outcomes? Summary Yes! BWAG Maybe? No!
30 Do Clinical Practice Guidelines Change Outcomes? Evidence! Summary Show Me The Data! Recommendations Cost-Containment
31 Do Clinical Practice Guidelines Change Outcomes? Summary
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