Implementation of Healthcare Quality Improvement Programs

Cardiovascular Diseases/mortality; Prevalence; Guidelines as Topic; Aging; Risk Factors; Bed Occupancy; Drug Therapy; Quality Improvement; Cost Savings

The incidence and prevalence of cardiovascular disease are increasing worldwide.¹ - ³ This is partly due to population aging and the accumulation of risk factors associated with these diseases. In Brazil, the life expectancy of the population in 2019 was estimated at 76.6 years in a population of 211,652,819 people, assessed by IBGE. In the same year, approximately 12,168,390 hospitalizations were registered in the public healthcare system (in Brazil, SUS) — Ministry of Health — with approximately 1,200,000 due to cardiovascular diseases (10% of the total).⁴ In addition, the mortality related to cardiovascular diseases remains high, around 29% of the annual causes of death.⁵ Therefore, we observe the great impact of these diseases with regard to the occupation of hospital beds and mortality in Brazil. In this scenario, chronic disease management programs have shown that monitored and multidisciplinary monitoring improves adherence to pharmacological and non-pharmacological treatment determines optimization of therapy, decreases the number of hospitalizations directly related to the disease, promoting an important improvement in the quality of life and reduction of hospital costs.⁶ - ⁸ Brazilian records have shown adherence to extremely low medical guidelines.⁹ The reasons for poor performance in implementing clinical guidelines include barriers related to the health system itself, medical commitment and improvement, multidisciplinary involvement and the patient’s own involvement in healthcare. Some studies suggest that about 30%–40% of patients do not receive healthcare according to the current scientific evidence, while 20% or more of the healthcare provided are not necessary or potentially harmful. The strategies developed to optimize adherence to current guidelines have demonstrated success in the management of these patients. This chronic disease management, focused on the quality of evidence-based care, can promote the reduction of clinical events. Some studies on management and quality improvement have shown reduced rates of hospital readmission in 30 days with the adoption of these measures.¹⁰ , ¹¹ Other models, in performance monitoring associated with strategies for implementing guidelines, promote the improvement of healthcare and reduction of outcomes. The encouragement of healthcare and quality measures are heterogeneous in different regions and among Brazilian institutions, resulting in extremely varied outcomes. The association of performance measures, detection of opportunities for improvement and development of strategies to increase adherence to good health practices are fundamental to optimize results.

In this scenario, the development of national protocols and studies on the management of cardiovascular diseases, focusing on the implementation of models and tools to improve the quality of healthcare and implementation of adherence to best practices, has a fundamental role in assessing feasibility and results.¹²

Referências

• ¹
  Véronique LR, Go AS, Lloyd-Jones DM, Robert J. Adams RJ, Berry JD, Brown TM, et al. Heart Disease and Stroke Statistics--2011 Update: A Report From the American Heart Association. Circulation. 2011; 123:e18-e209.
• ²
  Roger VL. Epidemiology of Heart Failure. Circ Res. 2013 ;113:646-59
• ³
  Schocken DD, Benjamin EJ, Fonarow GC, Krumholz HM, Levy D, Mensah GA, et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group;and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation . 2008 ;117(19):2544-65.
• ⁴
  Brasil. Ministério da Saúde. DATASUS. [Citado em 2020 fev 12]. Disponível em http// www.datasus.org.br .
  » www.datasus.org.br
• ⁵
  Mansur A, Favarato D. Mortalidade por Doenças Cardiovasculares no Brasil e na Região Metropolitana de São Paulo: Atualização 2011. Arq Bras Cardiol 2012;99(2):755-61.
• ⁶
  Sudharshan S, Novak E, Hock K, Scott MG, Geltman EM. Use of Biomarkers to Predict Readmission for Congestive Heart Failure. Am J Cardiol 2017 ;119(3):445-51.
• ⁷
  Rich M W, Beckham V, Wittenberg C,. Leven CL, Freedland KE, Carney RM. A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure. N Engl J Med.1995 Nov 2;333(18):1190-5.
• ⁸
  Feltner C, Jones CD, Cené CW, Zheng ZJ, Coker-Schwimmer EJL. Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure: A Systematic Review and Meta-Analysis. Ann Intern Med. 2014 , 160(11):774-84.
• ⁹
  Albuquerque DC, Souza Neto JD, Bacal F, Rohde LEP, Bernardez-Pereira S, Berwanger O, et al. I Registro Brasileiro de Insuficiência Cardíaca – Aspectos Clínicos, Qualidade Assistencial e Desfechos Hospitalares. Arq Bras Cardiol. 2015 ;104(6):433-42.
• ¹⁰
  Bradley EH, Curry L, Horwitz LI, Sipsma H, Wang Y, Walsh MN, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. CircCardiovascQual Outcomes. 2013 Jul;6(4):444-50
• ¹¹
  Simpson M. A Quality Improvement Plan to Reduce 30-Day Readmissions of Heart Failure Patients. J Nurs Care Qual. 2013 ;29(3):280-6.
• ¹²
  Taniguchi FP, Bernardez-Pereira S, Silva AS, Ribeiro ALP, Morgan L,. Curtis AB, et al. Implementação do Programa Boas Práticas em Cardiologia adaptado do Get With The Guidelines® em Hospitais Brasileiros: Desenho do Estudo e Fundamento. Arq Bras Cardiol. 2020 ; 115(1):92-99.

• Short Editorial related to the article: Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get with the Guidelines in Brazilian Public Hospitals: Study Design and Rationale

Publication Dates

• Publication in this collection
  07 Aug 2020
• Date of issue
  July 2020