Continuous quality improvement increases use of process measures in hospitals performing coronary artery bypass surgery

Lindenauer, Peter K. MD, MSC, FACP

Tufts University School of Medicine; Division of Healthcare Quality, Baystate Medical Center, USA

Abstracted from:Ferguson T, Peterson E, Coombs L et al. Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. JAMA 2003; 290: 49-56 .

Sources of funding: This study was funded in part by the Society of Thoracic Surgeons from the Agency for Healthcare Research and Quality.

Correspondence to: T Bruce Ferguson Jr, Department of Surgery and Cardiovascular Outcomes Research Group, Louisiana State University Health Sciences Center, New Orleans. E-mail: [email protected]

Abstract provided by Bazian Ltd., London

Evidence-based Healthcare 8(1):p 1-3, March 2004.

BACKGROUND

Continuous quality improvement (CQI) is a repetitive cycle of process and outcomes assessment. When applied to health care, interventions to improve process of care are developed, implemented and assessed to determine their effect on the quality of care. To date, the effectiveness of CQI on quality improvement in medicine is yet to be determined.

OBJECTIVE

To assess the impact of low-intensity CQI interventions on the adoption of process of care measures in people undergoing coronary artery bypass surgery (CABG).

SETTING

Hospitals in the USA; January to November 2001.

METHOD

Cluster randomised controlled trial.

PARTICIPANTS

Three hundred and fifty-nine academic and non-academic hospitals performing cardiac surgery.

INTERVENTION

Hospitals were randomised to one of three groups. Two groups received low-intensity CQI interventions and received material on properative β-blockade therapy (n=124) or on internal mammary artery (IMA) grafting in elderly people (n=120). The control group received no intervention material (n=115). Intervention materials, delivered to the CQI leader and the data manager at each site at three time points over 11 months, comprised: process-measure data (consisting of scientific evidence for the use of data and site-specific data illustrating performance against regional, national and 'best practice' benchmarks); an action plan for CQI, and additional CQI educational materials.

OUTCOMES

Change in use of either preoperative β-blockade therapy or IMA grafting in people undergoing CABG surgery.

MAIN RESULTS

Both β-blockade and IMA grafting CQI significantly increased β-blockade therapy compared with control (β-blockade versus control, p < 0.001; IMA grafting versus control, p=0.02). β-blockade significantly increased at β-blockade CQI sites, measured from baseline (7.3% after β-blockade CQI versus 5.4% after IMA grafting CQI versus 3.6% for control; see Table 1). IMA grafting increased in the IMA grafting CQI group compared with the control group, although the difference was not significant.

Table 1 Change in process use after low-intensity continuous quality improvement interventions
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AUTHORS' CONCLUSIONS

A low-intensity continuous quality improvement strategy increases β-blockade therapy in hospitals performing coronary artery bypass surgery.