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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Impact of a cardiac risk reduction program in vulnerable patients hospitalized with coronary artery disease
Mori J Krantz1, Edward P Havranek, Philip S Mehler
1Department of Medicine, Denver Health Medical Center, University of Colorado Health Sciences Center, 80204-4507, USA. Mkrantz@dhha.org
Insights
A nurse-led quality improvement program significantly increased guideline-based medication use in coronary artery disease (CAD) patients, including vulnerable populations. This initiative improved care for disadvantaged patients receiving inpatient services.
Area of Science:
- Cardiology
- Quality Improvement
- Health Disparities
Background:
- Vulnerable populations, including ethnic minorities and low-income individuals, often experience disparities in care for coronary artery disease (CAD).
- Guideline-based pharmacotherapy is crucial for managing CAD, but its uptake can be suboptimal in disadvantaged patient groups.
- Nurse-led interventions show promise in addressing quality gaps in healthcare delivery.
Purpose of the Study:
- To enhance the utilization of guideline-recommended pharmacotherapy for coronary artery disease (CAD) in vulnerable patient demographics.
- To evaluate the effectiveness of a nurse-based quality improvement program in an inner-city hospital setting.
- To assess the impact of the program on medication adherence and patient counseling, irrespective of sociodemographic factors.
Main Methods:
- A retrospective program evaluation design was employed.
- A nurse-management program was implemented for 151 inpatients with angiographically confirmed CAD.
- Intervention included patient counseling with culturally appropriate materials and physician education; outcomes were compared to 125 historic controls using multivariable logistic regression.
Main Results:
- Patients receiving the nurse-management intervention showed significantly higher rates of statin (71% vs. 52%) and angiotensin-converting enzyme inhibitor (79% vs. 51%) use at discharge.
- These improvements in guideline-based pharmacotherapy persisted after adjusting for sociodemographic factors and baseline characteristics.
- A positive trend was observed for aspirin and beta-blocker use, alongside increased smoking cessation counseling for the intervention group.
Conclusions:
- An inpatient nurse-management program effectively improved the quality of care for coronary artery disease (CAD) patients, including those from vulnerable backgrounds.
- Disease management initiatives, when properly designed, can successfully bridge care gaps for disadvantaged populations accessing healthcare through inpatient and emergency services.
- Nurse-led quality improvement strategies are valuable for promoting equitable and evidence-based pharmacotherapy in diverse patient populations.
Study Objective:
To increase the use of guideline-based pharmacotherapy in vulnerable patients (ethnic minorities and the poor) with coronary artery disease (CAD) through a nurse-based quality-improvement program.
Design:
Retrospective program evaluation.
Setting:
Inner-city hospital in Denver, Colorado.
Patients:
One hundred fifty-one consecutive patients hospitalized with a CAD-related diagnosis.
Intervention:
A nurse-management program was initiated for patients with angiographically documented CAD, and rates of guideline-based care were compared with rates for historic controls. The intervention consisted of two key elements: patient counseling with language-appropriate education materials and direct physician education regarding the importance of cardioprotective drugs. The 151 patients in the intervention group were compared with 125 historic control patients hospitalized before the program was begun. Multivariable logistic regression analysis was used to assess differences in care with regard to ethnicity, education level, and insurance status, and to adjust for different baseline characteristics.
Measurements And Main Results:
At hospital discharge, patients in the intervention group were more likely to receive statins (71% vs 52%, p=0.001) and angiotensin-converting enzyme inhibitors (79% vs 51%, p<0.001) compared with controls. These differences remained after adjusting for ethnicity, education level, insurance status, and baseline clinical characteristics. Also, a trend was noted toward greater use of aspirin (92% vs 86%, p=0.13) and beta-blockers (79% vs 73%, p=0.24) in the intervention group compared with controls. Patients in the intervention group were more likely to receive counseling for smoking cessation.
Conclusion:
An inpatient nurse-management program improved the quality of care for patients with CAD regardless of sociodemographic status. Properly designed disease-management initiatives can be effective for disadvantaged patients, who often obtain health care through emergency and inpatient services.
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