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Tools for acute coronary syndromes from Northern California Kaiser Permanente.

Systematic efforts have been in place since the early 1990s at Kaiser Permanente Northern California to implement evidence-based cardiovascular guidelines with the goal of reducing mortality in coronary artery disease (CAD) patients. The program is supported at each KPNC facility by a multidisciplinary team of champions involving cardiologists, intensivists, emergency room physicians, internists, critical care nurses, and pharmacists. Systematic follow-up after discharge via MULTIFIT and the Cholesterol Management Program assures that patients continue to receive recommended care. Kaiser Permanente’s standing orders and preprinted discharge template ACS sheets that promote adherence to both AMI and secondary prevention guidelines during inpatient care are offered below (Figs. 1–7). These strategies have produced improved patient outcomes. From 1996 to 1999 in KPNC, LDL control (LDL 130) in CAD patients improved from 22% to 81%. The number of eligible patients discharged post-MI on beta-blockers in 1999 was 97%. After ageand sex-adjustment, heart disease mortality is more than 30% lower in the KPNC population than in the non-KPNC California population. Of the 16 northern California hospitals recognized by the Office of Statewide Health Planning and Development as having markedly significant lower AMI mortality than expected, 9 were Kaiser facilities. Northern California Kaiser Permanente reviews and updates its internal guidelines, implementation tools, and preprinted orders on a 1to 2-year basis to reflect changes in ACC/AHA Guideline recommendations.