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Date: Tuesday, May 16, 1995
FOR IMMEDIATE RELEASE 
Contact:  HCFA Press Office (202) 690-6145

HCFA Launches National Program to Improve Care
for Medicare Patients Hospitalized for Heart Attack

The federal Health Care Financing Administration is implementing a national program to improve care for Medicare patients hospitalized for a heart attack by increasing the use of treatments already known to be effective.

HCFA has just completed a four-state study to identify ways in which care for Medicare beneficiaries with heart attacks can be improved. It found opportunities to expand the number of patients receiving standard treatments and to deliver those treatments more rapidly. The study appears in Wednesday's edition of the Journal of the American Medical Association.

"This project illustrates significant opportunities we have to improve care," said HCFA Administrator Bruce C. Vladeck. "Each year Medicare beneficiaries have more than a quarter of a million heart attacks. If we can bring their care up to best practices, we should be able to save thousands of lives. That is why we are extending the project to the entire nation."

The information from this project will be used by Medicare's Peer Review Organizations (PROs). They are government contractors in each state whose job is to promote improved care for Medicare beneficiaries. They will work in partnership with doctors and hospitals to improve care and to measure the improvement.

For example, doctors have known for years that aspirin and drugs called beta blockers can save lives after a heart attack, but this study found that a sixth of patients most likely to benefit from aspirin and more than half of patients most likely to benefit from beta blockers did not receive those drugs when they were discharged from the hospital. PROs are helping hospitals and physicians identify specific ways to be sure that all patients who can benefit from the drugs receive them.

"Through the Peer Review Organizations, we are providing technical assistance to hospitals on improving care and will be monitoring the results," Vladeck said.

Another example is drugs that dissolve clots in the heart's blood vessels, which are an important advance in treating heart attacks. The majority of patients who received such a drug waited more than an hour for it after reaching the hospital emergency room. The National Heart, Lung, and Blood Institute recommends a wait of no longer than 30 minutes. PROs are working with hospitals to identify ways in which care can be speeded.

The study was conducted in Alabama, Connecticut, Iowa and Wisconsin. "This project shows that we can identify important opportunities to improve care when we work in partnership with doctors and hospitals," Vladeck said.

The study used 11 quality indicators that are largely based on guidelines published by the American College of Cardiology and the American Heart Association in 1990. The guidelines were updated and adapted for the study with the assistance of a steering committee convened by the Health Care Financing Administration and the American Medical Association. The committee included representatives of major medical specialty societies.

The study concludes that "hospitals and physicians who apply these quality indicators to their practices are likely to find significant opportunities for improvement."

The study is part of HCFA's Health Care Quality Improvement Program, which is a broad effort to improve care for Medicare and Medicaid beneficiaries.

The article's authors -- all physicians -- are Edward Ellerbeck and Stephen Jencks, HCFA; Martha Radford, Connecticut Peer Review Organization (PRO), Middletown, Conn., and Department of Cardiology, University of Connecticut, Farmington, Conn.; Timothy Kresowik, Iowa Foundation for Medical Care, Des Moines, Iowa, and Department of Surgery, Iowa University, Iowa City, Iowa; Alan Craig, Alabama Quality Assurance Foundation and the Department of Internal Medicine, University of Alabama, Birmingham, Ala.; Jay A. Gold, Wisconsin PRO, Madison, Wis., and the Department of Preventive Medicine, Medical College of Wisconsin, Milwaukee, Wis., and the University of Wisconsin, Madison, Wis.; Harlan M. Krumholz, Connecticut PRO and Cardiovascular Section, Yale School of Medicine, New Haven, Conn.; and Robert Vogel, Department of Cardiology, University of Maryland, Baltimore, Md.

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