Implementing a Cardiology Quality Incentive Program to Improve Guideline-Directed Medical Therapy.

BACKGROUND

Adherence to guideline-directed medical therapy (GDMT) is central to quality-improvement programs, although the impact of financial incentive programs has been mixed.

OBJECTIVES

The purpose of this study was to the impact of a cardiovascular population health initiative that integrates financial incentives, robust data infrastructure, and electronic health record clinical decision support on improving GDMT for cardiovascular disease (CVD).

METHODS

The program was implemented across 15 ambulatory clinics with 54 cardiologists in an academic health system. Individualized CVD patient panels were created for each provider, and providers received quarterly performance and incentive reports. Quality metrics included antiplatelet and statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease prevention, blood pressure control, and GDMT for heart failure with reduced ejection fraction (HFrEF; specified beta blockers; ACEI, ARB, or ARNI; mineralocorticoid receptor antagonist). An interrupted time series analysis evaluated monthly, 1-year, and 2-year changes in the odds of adhering to each specific metric associated with the implementation of the cardiovascular population health program.

RESULTS

After the intervention, the composite HFrEF therapy metric improved significantly (2-year odds ratio [OR]: 2.285; 95% confidence interval [CI]: 1.653-3.158; P < 0.001). Individual metrics also improved, including mineralocorticoid receptor antagonist (2-year OR: 3.039; 95% CI: 2.520-3.663; P < 0.001); specified beta blockers (2-year OR: 1.430; 95% CI: 1.129-1.810; P = 0.003); angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor therapy for HFrEF (2-year OR: 1.228; 95% CI: 1.001-1.505; P = 0.049); statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease (2-year OR: 1.146; 95% CI: 1.092-1.202; P < 0.001); and blood pressure control (2-year OR: 1.496; 95% CI: 1.444-1.550; P < 0.001).

CONCLUSIONS

Our program was associated with sustained improvements in GDMT adherence for CVD. It may serve as a scalable model for enhancing the quality of cardiovascular care.