# Presentation: 207438

## Ischemic Heart Disease QUERI

**IHD-QUERI **
-    Ischemic heart disease (IHD) is the leading cause of death in the U.S costing $100 billion annually. Acute myocardial infarction and unstable angina account for over 25,000 admissions a year to VA facilities.
- 	The primary goal of IHD-QUERI is to assess and improve the quality of care and quality of life for VA patients with IHD.

**IHD-QUERI Activities**
- Close collaboration with Patient Care Services and the Office of Quality and Performance to improve outcomes for Acute Coronary Syndrome (ACS) patients across VHA
- Improving the quality of care and quality of life for patients with chronic stable angina
- Improving secondary prevention of IHD with emphasis on lipid management.

**Secondary Prevention**
-       Multifaceted primary care interventions included point of care reminders (both computerized and paper), pharmacist-run lipid clinics, audit and feedback, and order templates.  All interventions piloted in VISN 20 have demonstrated moderate positive effects on specific process improvements:
******         ****LDL-c measurement                                                                 **
******         ****Lipid lowering agent use**
******         ****# of patients at LDL-c goal**
- 	10% reduction in mean LDL-c values observed during the intervention period in VISN 20  estimated 17% reduction in adverse cardiac events and resultant prevention of  75 major coronary events in VISN 20 annually
**	****Are patients compliant with statins?**
-      Retrospective study of 8,768 male VA patients with IHD over 18 month follow-up period.  Prescribed statins in the period from 7/1/1999 to 6/30/2000:
- 	71% were compliant over the 18 month period. Persistence in use of statins in our population was higher than in other open population cohorts (estimates range from 20 – 40% compliance).
**Evidence from IHD-QUERI and EPRP suggests the VA outperforms other health care providers in many secondary prevention activities for IHD.  Challenges remain in control of hypertension and prescribing all guideline recommended medications.**

**Cardiac Assessment, Reporting, and Tracking –Cath Lab **
- IHD QUERI is creating a national VA Cath Lab Database including software for data entry and report generation. This system will standardize data collection, data sharing and benchmarking to national standards.
- Features include:
-   ACC-National Catheterization Data Repository (NCDR) data elements
-   Logical and flexible application designed by clinicians
-   Generates reports for direct entry into CPRS
-   Feeds into a national database
-   Integrated with CPRS
- CART-CL is in beta test prior to national rollout planned for early next year.

| Current Activities |
| --- |

**Improving the Management of Chronic Stable Angina:**
- Project to test effectiveness of a collaborative care model to improve health status and quality of life for VA patients with chronic stable angina
- Conducted in General Internal Medicine Clinics in four VA Medical Centers: Denver, Palo Alto, Portland and Puget Sound.

| 
Cardiac Care Follow-up Clinical Study
In collaboration with the Cardiology Program Office in Patient Care Services and the Office of Quality and Performance, IHD-QUERI is focusing on the following critical measures of ACS care:

  Completeness and timeliness of risk stratification and diagnosis
  Timeliness of reperfusion
  Patient transfer between non-tertiary and tertiary medical centers
  Delivery of guideline-recommended revascularization, intensive medical management, and
	discharge medications
 30-day, 60-day, 90 day and 1 year mortality stratified by risk and disease severity: 

Using national VA databases |
| --- |

**Planned  Activities**
**Evaluating Impact of System Change on Quality of Care for ACS**
**Objectives:**
- Compare patient characteristics, processes of care, and risk-adjusted in-hospital mortality and other patient outcomes including health related quality of life with non-VA patients in the PREMIER and CRUSADE registries
- Ascertain the sensitivity of case-finding methods for ACS in EPRP
- Evaluate structural and process changes in cardiac care infrastructure throughout VHA and associations with patient outcomes
**   **
** ****Contact:  ****Sandra Pineros, MPH, Administrative Coordinator, VA Puget Sound Health Care System (S-152), 1660 S. Columbia Way, Seattle, Washington  98108 Tel: 206/764-2822, Fax: 206/764-2925, e-mail: sandra.pineros@med.va.gov**

**Research Repository for ACS patients for the purpose of quality improvement**

**EPRP**

**SHEP**

**AAC and PSSG**

**PBM**

**NCPD**

- Mean LDL

**Executive Committee**
- 	Stephan Fihn, MD MPH, Research Coordinator**,** VA Puget Sound HCS
- 	Ken Morris, MD Clinical Coordinator, Durham VAMC
- 	Anne Sales, MSN PhD, Implementation Coordinator, VA Puget Sound HCS
- 	Jeroan Allison, MD MS, University of Alabama
- 	Ross Fletcher, MD, Washington, DC VAMC
- 	Mary Goldstein, MD, MSc, VA Palo Alto
- 	Frederick Grover, MD, University of Colorado
- 	Karl Hammermeister, MD, Eastern Colorado VAHCS
- 	Paul Heidenreich, MD MS, VA Palo Alto
- 	Robert Jesse, MD PhD, Richmond VAMC and Program Director for Cardiology, Office of Patient Care Services
- 	Greg Larsen, MD, Portland VAMC
- 	Laura Petersen, MD MPH, Houston VAMC
- 	Eric Peterson, MD MPH, Duke University
- 	John Rumsfeld, MD PhD, Eastern Colorado VAHCS
- 	Mark Starling, MD, Ann Arbor VAHCS