Using "get with the guidelines" to prevent recurrent cardiovascular disease.

Clinical trials and guidelines provide strategies to reduce the rate of recurrent events in patients with cardiovascular disease. Despite multiple therapeutic options to enhance secondary prevention, many patients leave the hospital without these basic interventions. Delivery of secondary prevention is critically dependent on systems to ensure reliable delivery. The implementation of successful systems requires physician leadership, compatibility with hospital strategic priorities, multidisciplinary teams, use of tools such as preprinted orders and discharge protocols, and concurrent data collection and feedback. The process of testing and implementing effective systems is best done in a collaborative where teams from multiple hospitals share successes and lessons that were learned. Community level collaboratives also create momentum to gain support at the hospital level. The combination of collaborative learning with technology for data collection, feedback, and decision making is useful to move multiple hospitals to higher levels of performance in critical measures of secondary prevention.