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Keywords:

  • vulnerable patients;
  • coronary artery disease;
  • quality improvement;
  • clinical guidelines;
  • Get with the Guidelines Program;
  • American Heart Association

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 β-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.