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Published on: April 19, 2019
Implementing a Cardiology Quality Incentive Program to Improve Guideline-Directed Medical Therapy
David J Cho1, Pooya I Bokhoor1, Anna Dermenchyan2
1Department of Medicine, Division of Cardiology, UCLA Health, Los Angeles, California, United States.
Insights
A cardiovascular population health initiative significantly improved guideline-directed medical therapy (GDMT) adherence for cardiovascular disease (CVD). This scalable model integrates financial incentives and electronic health record support for enhanced quality of care.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Quality Improvement
Background:
- Guideline-directed medical therapy (GDMT) adherence is crucial for cardiovascular disease (CVD) quality improvement, yet financial incentive programs show mixed results.
- Effective strategies are needed to enhance GDMT adherence in clinical practice.
Purpose of the Study:
- To evaluate a cardiovascular population health initiative combining financial incentives, data infrastructure, and EHR clinical decision support.
- To assess the impact of this initiative on improving GDMT for CVD.
Main Methods:
- Implementation across 15 clinics with 54 cardiologists within an academic health system.
- Utilized individualized patient panels, provider performance reports, and incentive structures.
- Interrupted time series analysis to evaluate changes in adherence to key CVD metrics.
Main Results:
- Significant improvement in composite heart failure with reduced ejection fraction (HFrEF) therapy adherence (2-year OR: 2.285, P < 0.001).
- Sustained improvements observed in mineralocorticoid receptor antagonist use (2-year OR: 3.039, P < 0.001), beta blockers, ACEI/ARB/ARNI, statin/PCSK9i therapy, and blood pressure control.
- All key quality metrics demonstrated statistically significant improvements post-intervention.
Conclusions:
- The population health initiative led to sustained improvements in GDMT adherence for CVD.
- This integrated approach offers a scalable model for advancing cardiovascular care quality.
Background:
Adherence to guideline-directed medical therapy (GDMT) is central to quality-improvement programs, although the impact of financial incentive programs has been mixed.
Objectives:
The purpose of this study was to the impact of a cardiovascular population health initiative that integrates financial incentives, robust data infrastructure, and electronic health record clinical decision support on improving GDMT for cardiovascular disease (CVD).
Methods:
The program was implemented across 15 ambulatory clinics with 54 cardiologists in an academic health system. Individualized CVD patient panels were created for each provider, and providers received quarterly performance and incentive reports. Quality metrics included antiplatelet and statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease prevention, blood pressure control, and GDMT for heart failure with reduced ejection fraction (HFrEF; specified beta blockers; ACEI, ARB, or ARNI; mineralocorticoid receptor antagonist). An interrupted time series analysis evaluated monthly, 1-year, and 2-year changes in the odds of adhering to each specific metric associated with the implementation of the cardiovascular population health program.
Results:
After the intervention, the composite HFrEF therapy metric improved significantly (2-year odds ratio [OR]: 2.285; 95% confidence interval [CI]: 1.653-3.158; P < 0.001). Individual metrics also improved, including mineralocorticoid receptor antagonist (2-year OR: 3.039; 95% CI: 2.520-3.663; P < 0.001); specified beta blockers (2-year OR: 1.430; 95% CI: 1.129-1.810; P = 0.003); angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor therapy for HFrEF (2-year OR: 1.228; 95% CI: 1.001-1.505; P = 0.049); statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease (2-year OR: 1.146; 95% CI: 1.092-1.202; P < 0.001); and blood pressure control (2-year OR: 1.496; 95% CI: 1.444-1.550; P < 0.001).
Conclusions:
Our program was associated with sustained improvements in GDMT adherence for CVD. It may serve as a scalable model for enhancing the quality of cardiovascular care.
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