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Implementing the Guidelines: Critical Pathways Awareness Is Not Enough! NCEP, National Cholesterol Education Program. Pearson TA, et al. Arch Intern Med. 2000;160:459-467. 95% 38% 0 20 40 60 80 100 Physician Awareness of NCEP Guideline Patient Treated to Goal Sample (%) GUIDELINES Cardiology Acute Care Primary Care Secondary Prevention Smooth Transition From Acute to Long-term Management Why Develop Critical Pathways? “ A treatment gap between therapy that is dictated by evidence-based medicine and therapy that occurs in practice is not a deficit of knowledge; rather, it is a deficit of implementation. ” Sidney Smith, MD Chief Scientific Officer, American Heart Association ? Standardized protocols ? Goal: optimize care ? Emerging Evidence — Pathways work: ? CHAMP ? Guidelines Applied in Practice (GAP) ? AHA Get with the Guidelines program www. critpathcardio .com CHAMP, Cardiac Hospitalization Atherosclerotic Management Program. UCLA: CHAMP Study ? Designed to determine whether physician/patient compliance with preventive therapies can be improved through a hospital-initiated program ? Tracked initiation of ASA, ?-blocker, ACE inhibitor, and statins ? Used preprinted orders, guidelines, lectures, discharge forms ? Population: Patients with symptomatic atherosclerosis treated at university-associated teaching hospital ASA, acetylsalicyclic acid; ACE, angiotensin -converting enzyme. Fonarow GC, et al. Am J Cardiol . 2000;85;10A-17A. Cardiac Hospitalization Atherosclerosis Management Program CHAMP Study: Treatment Rates at Discharge and 1-Year Follow-up CHAMP, Cardiac Hospitalization Atherosclerotic Management Program. *P <.01 pre- vs post-CHAMP at discharge and at 1 year. Fonarow GC, et al. Am J Cardiol . 2001;87:819-822. 0 50 100 Pre-CHAMP Discharge Post-CHAMP Discharge Pre-CHAMP Follow-up Post-CHAMP Follow-up Aspirin ?-Blocker Treatment Rates (%) 78 92 * 68 94 * 12 61 * 18 57 * CHAMP Study: Clinical Events for the First