Evidence of disparity in the application of quality improvement efforts for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice Initiative in Michigan
| Autor: | Bonnie Motyka Vautaw, Adam M. Rogers, Vijay S. Ramanath, Mary Grzybowski, Elizabeth A. Jackson, Canopy Roychoudhury, Kim A. Eagle, Adesuwa Olomu, Benrong Chen |
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| Rok vydání: | 2008 |
| Předmět: |
Counseling
Male medicine.medical_specialty Michigan medicine.medical_treatment Adrenergic beta-Antagonists Myocardial Infarction Disease Medicare Drug Prescriptions White People Cohort Studies symbols.namesake Health care medicine Humans Myocardial infarction Medical prescription Healthcare Disparities Fisher's exact test Societies Medical Aged Quality Indicators Health Care Aged 80 and over Aspirin Evidence-Based Medicine business.industry Racial Groups Guideline Middle Aged medicine.disease Patient Discharge United States Hospitalization Emergency medicine Practice Guidelines as Topic symbols Physical therapy Smoking cessation Female Smoking Cessation Guideline Adherence Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug Total Quality Management |
| Zdroj: | American heart journal. 159(3) |
| ISSN: | 1097-6744 |
| Popis: | Racial disparities exist in the management of patients with cardiovascular disease in the United States. The aim of the study was to evaluate if a structured initiative for improving care of patients with acute myocardial infarction (Guidelines Applied in Practice [GAP]) led to comparable care of white and nonwhite patients admitted to GAP hospitals in Michigan.Medicare patients comprised 2 cohorts: (1) those admitted before GAP implementation (n = 1,368) and (2) those admitted after GAP implementation (n = 1,489). The main outcome measure was adherence to guideline-based medications/recommendations and use of the GAP discharge tool. chi(2) and Fisher exact tests were used to determine differences between white patients (n = 2,367) and nonwhite patients (n = 490).In-hospital GAP tool and aspirin use significantly improved for white and nonwhite patients. beta-Blocker use in hospital improved significantly for nonwhite patients only (66% vs 83.3%; P = .04). At discharge, nonwhite patients were 28% and 64% less likely than white patients to have had the GAP discharge tool used (P = .004) and receive smoking cessation counseling (P.001), respectively. Among white patients, GAP improved discharge prescription rates for aspirin by 10.8% (P.001) and beta-blockers by 7.0% (P = .047). Nonwhite patients' aspirin prescriptions increased by 1.0% and beta-blocker prescriptions decreased by 6.0% (both P values nonsignificant).The GAP program led to significant increases in rates of evidence-based care in both white and nonwhite Medicare patients. However, nonwhite patients received less quality improvement discharge tool and smoking cessation counseling. Policies designed to reduce racial disparities in health care must address disparity in the delivery of quality improvement programs. |
| Databáze: | OpenAIRE |
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