The HCA national disease management program for coronary disease detectionand treatment in women

The diagnosis and treatment of heart disease in women continues to be one o f the greatest challenges facing cardiovascular medicine today. Marked redu ctions in mortality rates during the past 2 decades did not result in impro ved outcomes for women. A major rate-limiting step to improving mortality r ates for women is early diagnosis and initiation of effective lifesaving th erapies for women. In 1999, HCA Healthcare Systems, Inc, Nashville, TN, ini tiated a coordinated effort among 208 hospitals in 26 states to improve the diagnosis of coronary disease and to target women who should receive aggre ssive risk factor modification and referral to cardiologists. We describe t he initial phases of program development, including employee risk factor sc reening; citywide health risk assessment; nationwide educational programs f or clinicians, staff, and consumers; and a dedicated outcomes assessment pr ogram for tracking women at risk for coronary disease. We believe that thes e efforts provide a venue for optimal care and improved outcomes for women served by HCA facilities.