Hospitals standardize heart care

The American Heart Association has published guidelines to ensure that all patients with coronary artery disease, heart failure and stroke get standardized treatments.

In the past, if five doctors were in a room consulting on patient treatments, "you got 10 different opinions," said cardiologist William Dang Jr. With the guidelines, he said, "It stops all arguments."

The heart association and American College of Cardiology put a blue ribbon panel together in 2001 that reviewed all studies and drafted the first guidelines for coronary heart disease, said Dang, volunteer chairman of the AHA Hawaii Get With the Guidelines cardiology and heart failure programs.

Guidelines for stroke treatment were released last year and those for heart failure were released earlier this year. "Get With the Guidelines" is one component of HMSA's Hospital Quality Service and Recognition Program, with hospitals scored on different points for participation and achieving goals.

"It's not just a report card or publicity thing, but HMSA put money where its mouth was and rewarded the hospitals with financial incentives based on how they scored," Dang said.

In the first year, HMSA paid $364,000 in financial incentives to 11 of 13 eligible hospitals for using the coronary artery disease guidelines. Last year, 11 hospitals received awards totaling $315,644.

"We did increase difficulty of scoring for 2005," said Dr. John Berthiaume, who oversees reimbursements to hospitals as HMSA vice president and medical director of care management.

If all the hospitals had scored maximum points, the awards would have totaled more than $800,000, according to one of the analysts, Berthiaume said.

HMSA also will reimburse hospitals this year for participating in guidelines for stroke treatment, he said. The AHA reported that 85 percent of Hawaii hospitals were participating in the guidelines program in 2004 -- the highest rate of any state.

"The purpose of the whole program was to monitor people admitted with heart disease and make sure they were discharged with evidence-based guidelines to help them stay healthy with heart disease," Berthiaume said.

Data is collected specifically for quality improvement, comparing local hospital performance with that of regional and national hospitals, he said. "We really liked this."

The guidelines essentially provide "a checklist" for doctors, Dang said, explaining the program involves repeat training for physicians and hospital staff, "so not just hospital doctors but all the hospital staff has increased responsibility."

"Helpful guides" also were designed that follow patients, he said. "It's a real team approach so things have less trouble falling through cracks."

The Queen's Medical Center and Kaiser Permanente have received the heart association's Get With the Guidelines Stroke Initial Performance Award.

Dr. Cherylee Chang, director of Queen's Neuroscience Institute, and Dr. Sharin Sakurai, chief of the Department of Neurosciences at Kaiser, are volunteer co-chairs of the AGHA Hawaii Get With the Guidelines stroke program.

They said the hospitals had to achieve more than 90 percent compliance with the program's requirements to receive the performance award.

Chang said Queen's was one of the first hospitals to initiate the stroke guidelines after a pilot program. "These basically are national guidelines shown to improve either outcome or decreased mortality," she said.

They not only help to improve care for patients in the hospital but "get the patients going on measures that should be practiced after they leave the hospital, with behavioral life changes," she said.

Sakurai said, "It's about education at all levels," including doctors, nurses, physical therapy and rehabilitation staff.

Sakurai said she sees Get With the Guidelines as "a perfect way to develop a partnership at all levels with the patient as the ultimate partner." She said Kaiser will observe Stroke Awareness Day May 30 with educational information and other activities in the hospital lobby.

Lisa Taylor, whose job as AHA-Hawaii director of quality improvement is to help the hospitals implement the guidelines, said the three programs are considered separately and hospitals can join one or three.

The state has 17 acute care hospitals and 15 are participating in the programs. Thirteen are in the coronary artery disease program and six of those also are in the stroke program. Two others are in the stroke program and two in the heart failure program.

The heart association's goal for 2010 is to cut the cardiac and stroke death rate by 25 percent, he said.