Care that Benefits the Patient Most
"Guidelines Applied in Practice" bring consistency to cardiovascular care
based on best outcomes
Kim Eagle is an evangelist for the use of clinical care guidelines in the
treatment of cardiovascular disease. Developed by the American College of Cardiology
and the American Heart Association, guidelines are based on the latest scientific
research linking specific treatments with patient outcomes. The goal is to
help physicians select the safest and most effective treatment for their patients
with heart disease.
 Rajendra Mehta, Cecelia Montoye and Kim Eagle
Photo: Martin Vloet |
"The evidence shows there are about a dozen things, some as simple as prescribing
aspirin, that can have a substantial impact on the quality and outcome of cardiovascular
care," Eagle says. "But in the helter-skelter pace of modern medicine, it's
easy for health care providers to forget or overlook them. If these key priorities
are embedded in the clinical care process and if simple reminder systems are
provided for the doctor, nurse and patient, it helps everyone do a better job."
In 1994, Eagle began analyzing the impact of guideline-based care on U-M Health
System patients who were recovering from a heart attack. His initial study
led to a pilot grant from the American College of Cardiology to expand the
project to 10 other hospitals in southeast Michigan. Since then, Eagle and
others on his research team have introduced the American College of Cardiology's "Guidelines
Applied in Practice" to hospitals and cardiac care centers throughout Michigan
and in Ohio, Montana, West Virginia, Italy and Spain. Eagle works closely
with program co-director Cecelia Montoye and Rajendra Mehta, M.D., a clinical
assistant professor of internal medicine in cardiology.
A major obstacle to widespread adoption of clinical care guidelines, according
to Eagle, is getting physicians to agree on a common set of priorities. "Medicine
continues to be a cottage industry," he says. "State to state, town to town,
we see microclimates of health care influenced by various care providers, institutions,
insurers or employers. Getting all that variability to fall into line requires
strong physician leadership."
Eagle is proud of the means his team has developed to make it easier for doctors
to use guidelines in treating cardiovascular patients. In the U-M Health System,
for example, every medical student and resident receives a summary of the most
important guidelines printed on a laminated card that fits inside the pocket
of their lab coat. More detailed information is posted on the health system's
Web site where it is available to every physician in all U-M hospitals and
health centers. Nurses even review patient charts after discharge and report
back to the cardiovascular care team if guidelines aren't followed.
"The program has improved the quality of care and affected the lives of thousands
of patients worldwide," Eagle says. As the Cardiovascular Center continues
to grow, Eagle is looking forward to spreading the word on the importance of
guidelines to more physicians.
After all, he says, treating a heart attack patient without clinical care
guidelines is like piloting a 747 without using the pre-flight checklist. Maybe
you will remember all the different steps involved, but with people's lives
on the line, do you really want to take that chance?
-SFP
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