Improving outcomes in high-risk populations using REACH: an inpatient cardiac risk reduction program

The high prevalence of cardiovascular disease and its associated mortality rates mandate that risk reduction strategies be addressed in high-risk populations, including those diagnosed with atherosclerotic vascular disease, heart failure, and diabetes mellitus. Hospital-based systems that can identify and guide management of these high-risk populations can be effective adjuncts to patient care.In 2001, an inpatient cardiovascular risk assessment program called REACH was developed at Advocate Lutheran General Hospital (ALGH), a community teaching hospital in Illinois. REACH uses an intranet-based data repository capable of prospectively identifying high-risk patients by displaying an alert on the inpatient computerized medical record. Management and education protocols are accessed through various links. An assessment and treatment plan is incorporated into the discharge instructions and sent to the primary care physician.A total of 9035 patients at ALGH were included in the analysis (n = 2807 at baseline and n = 6007 at year 6). Adherence to pharmacological therapy and monitoring of lipid profile improved in all 5 of the inpatient populations. Statistically significant improvement was noted in all outcomes in the cardiovascular and stroke populations (P < 0.05). In populations with diabetes and heart failure, all but one showed a statistically significant improvement. In the peripheral vascular disease population, 2 of the 5 showed statistically significant improvement. Adherence to outcome criteria in all high-risk populations over the 6-year time frame resulted in a 119% change in guideline compliance.The REACH program successfully uses patient information systems to provide a quality improvement tool that promotes optimal patient management of high-risk vascular disease states.