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019 Successful Implementation of Cardiovascular Prevention and Treatment Guidelines in an Integrated Health Care System: Structure, Process and Outcomes
  1. J Harris1,
  2. M Jaffe2
  1. 1The Permanente Medical Group, San Rafael, USA
  2. 2The Permanente Medical Group, South San Francisco, USA


Background Evidence based guideline recommendations can support effective prevention and treatment of cardiovascular disorders, leading causes of morbidity and mortality in our population. Improvements result if recommendations are implemented in a uniform and effective manner.

Objectives To describe the process, structure and results of efforts to better manage cardiovascular risks and events in an integrated health system using organisational best practices; To present results of risk reduction, disease management and acute care programmes.

Methods Database analyses revealed opportunities for improvement. Pilot projects were conducted, followed by training about successful processes and practices, supported by organisational leaders. Ongoing comparative feedback supports improvements. Suggested order sets are incorporated in the EMR. Financial incentives for meeting targets accrue to medical centres.

Results The incidence of acute myocardial infarctions dropped significantly in the last 5 years, as did the mortality rate. Stroke mortality dropped significantly as well. The population levels of lipids, blood sugar, blood pressure and CHF control continue to improve.

Discussion Guideline recommendations were adopted across our delivery system when supported by top leadership, testing, training, specific care processes, EMR prompts for tests and treatments, regularly reviewed process metrics and group financial incentives. Practice variance was reduced and outcomes markedly improved.

Implications for Guideline Developers Guideline recommendations are more likely to be adopted in a uniform manner if they include specific recommendation, suggestions for implementation use in organised settings, and process and outcome metrics to track improvements.

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