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Care Based on Evidence
Evidence-based medicine is at the heart of quality care at Strong Health. It means that decisions made about care are based on guidelines drawn from reviewing the best available research, information, and experiences.
Throughout Strong, teams of experts are continually researching and identifying the best evidence-based practices. Their work often leads to the creation of guidelines, called clinical protocols and care pathways, that serve as “best practice standards” that physicians, nurses, and other professionals can apply to patient care. Use of these best practices helps to ensure the best results while allowing physicians and nurses the flexibility to tailor care to patients’ specific needs.
Two Examples of Evidence-Based Practice
Heart Attack
Among many evidence-based treatment standards at Strong is one we follow in caring for patients suffering from heart attacks (acute myocardial infarction/AMI). This protocol, one of several measured and reported by the Centers for Medicaid Services (CMS) Hospital Compare website, includes the following:
| Heart Attack Care Quality Measures | Brief Explanation of Treatment |
|---|---|
| Percent of Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD) | ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat heart attacks, heart failure, or a decreased function of the heart. |
| Percent of Patients Given Aspirin at Arrival | Aspirin can help keep blood clots from forming and dissolve blood clots that can cause heart attacks. |
| Percent of Patients Given Aspirin at Discharge | Taking aspirin may help prevent further heart attacks. |
| Percent of Patients Given Beta Blocker at Arrival | Beta blockers are a type of medicine used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack. |
| Percent of Patients Given Beta Blocker at Discharge | Beta blockers are a type of medicine used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack. |
| Percent of Patients Given PCI Within 120 Minutes of Arrival | The procedures called Percutaneous Coronary Interventions (PCI) are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform PCI, or give medicine to open the blockage, and in some cases, may do both. |
| Percent of Patients Given Smoking Cessation Advice/Counseling | Smoking is linked to heart attacks. Quitting may help prevent another heart attack. |
| Percent of Patients Given Thrombolytic Medication Within 30 Minutes of Arrival | Blood clots can cause heart attacks. Doctors may give this medicine, or perform a procedure to open the blockage, and in some cases, may do both. |
Adapted from U.S. Department of Health & Human Services Hospital Compare website.
Blood Clots
One of many examples of the effectiveness of evidence-based medicine — and the value of having a computerized provider order entry system (CPOE) — was seen when Strong Memorial Hospital took aim at a major safety target: deep-vein thrombosis, also known as blood clots.
Prior to the new system, Strong had a voluntary clinical guideline for preventing clots. Under a cooperative patient safety initiative, Strong Memorial Hospital, Highland Hospital, and three other Rochester-area hospitals put together a prevention program that included walking when possible, use of compression stockings or pads, and required early use of preventive medication, such as Heparin, at appropriate levels.
Although about 70% of people admitted to these hospitals have a high risk of clots, about 60% were not receiving preventive treatment. In the first three months trying the new guidelines, that level was cut to below 50%. Hospital leaders then re-emphasized the need and value of the initiative.
In the next phase, medical directors personally called physicians to ask them why individual patients did not receive preventive medication. Hospital pharmacists also helped. As a result, the number of patients who did not get the medication was reduced to less than 10%.
