Following the success of the AMI-GAP model, the Coalition launched a new GAP initiative to improve the care of patients with heart failure, reduce their risk of death, and lower re-admission to the hospital in nine Mid-Michigan hospitals. Undertaken in conjunction with the American College of Cardiology (ACC) and funded by pharmaceutical companies and the Blue Cross Blue Shield Foundation of Michigan, the new initiative was designed to facilitate inpatient compliance with ACC/American Heart Association (AHA) Guidelines for Heart Failure and patient transfer to a primary care physician.
Like the AMI-GAP project, the initiative made use of a toolkit that included ACC-endorsed standing orders, critical pathways, and a discharge checklist. Physician-nurse teams trained in guideline implementation worked with doctors and hospital staff to disseminate proven methods for implementing ACC/AHA guidelines.
Listed below are the nine hospitals across mid-Michigan that participated as intervention hospitals in this guideline adherence initiative:Mid-Michigan Guidelines Applied in Practice (GAP) – Heart Failure
- Bay Regional Medical Center
- Genesys Health System
- Hurley Medical Center
- Ingham Regional Medical Center
- Lapeer Regional Medical Center
- McLaren Regional Medical Center
- Memorial Healthcare
- Mid-Michigan Medical Center
- Saint Mary’s Health System
The project generated significant findings and resulted in valuable quality-improvement protocols that remain active in participant hospitals. The initiative brought a 22% reduction in 30-day readmission rates and a 27% reduction in 30-day mortality rates for heart failure patients in participating hospitals, as compared to controls.
The observed quality improvements—demonstrated in a non-academic, community hospital setting—represent important steps in quality care. What’s more, both AMI-GAP and GAP Heart Failure have been successfully replicated in several states, as well as other countries, and generated interest from major funders of health-related programs. In 2007, the Coalition reconvened the Cardiac Task Force to address methods of sustaining the project’s positive interventions.