Personalized site feedback does not improve upon 'Get With The Guidelines' results

An intervention designed to improve outcomes in heart failure patients by offering sites feedback on adherence to guidelines did not lead to better quality of care in hospitals, according to a cluster-randomized trial.

Lead researcher Adam D. DeVore, MD, of the Duke Clinical Research Institute in Durham, N.C., and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on July 14.

In 2005, the American Heart Association and American Stroke Association created the Get With The Guidelines-Heart Failure (GWTG-HF) program. To date, more than 1,900 hospitals have voluntarily participated in the in-hospital quality improvement program. The GWTG-HF collects information on 188 variables and provides hospitals with online reports detailing their adherence to guidelines and quality improvements. The current study from DeVore and colleagues sought to determine whether adding personalized site feedback on quality metrics would further improve outcomes beyond the basic GWTG-HF program.

Between Oct. 1, 2009, and March 31, 2010, the researchers analyzed data from 71,829 patients who were hospitalized for heart failure at 147 hospitals in the U.S. All of the hospitals had participated in the GWTG-HF program as of Oct. 1, 2009. They are not paid for participating. The study’s authors were also involved in the Get With The Guidelines program, and most were involved specifically in the heart failure program.

The hospitals were randomized to continue providing the GWTG-HF tools or to receive an intervention that included additional personalized quality improvement reports, teleconferences and webinars. The researchers worked closely with quality leaders at the hospitals. This was the first randomized trial within the GWTG-HF program.

A year after the intervention, both groups had similar changes in their composite quality score. In addition, there were no differences in the five achievement measures and the nine quality measures that were evaluated.

“We don’t have a solid answer [as to why the intervention did not improve outcomes],” DeVore told Cardiovascular Business. “We can’t point to one piece of evidence that says, ‘If we had done this, I think we would have been more successful.’ But I think some of the things we would consider for another round would be trying to get a better sense of the sites before we rolled out the intervention and then trying to get their feedback early on and allowing the intervention to change. Our goal with this was to have something that was flexible and allow the sites to experiment with what they liked and what they didn’t.”

Through the GWTG-HF program, hospitals have improved their adherence to guidelines over time, according to DeVore. He added that hospitals participating in the program have better adherence compared with other hospitals that do not participate.

“We feel like the program’s been quite successful,” DeVore said. “We’re still learning a lot. One of the great things about Get With The Guidelines is it’s trying to evolve over time. We are looking at different process measures and link them to outcomes. We’re still in an early phase of trying to understand that.”

DeVore said one limitation of the study was that the researchers did not collect information on what aspects of their intervention worked. 

“We don’t have a good sense of what aspects of the intervention were better than others,” he said. “I think that’s something that we would consider for future trials like this, to try to get a better sense of what information we’re presenting is actionable, what seems to be useful for the sites and then allowing that to change over time.”