Alabama coronary artery bypass grafting project: results of a statewide quality improvement initiative
Department of Quantitative Health Sciences
Medical Subject Headings
Aged; Alabama; Coronary Artery Bypass; Female; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; *Outcome and Process Assessment (Health Care); Professional Review Organizations; Statistics, Nonparametric; Surgery Department, Hospital; Survival Analysis; *Total Quality Management; United States
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
CONTEXT: Efforts to improve quality of care in the cardiac surgery field have focused on reducing the risk-adjusted mortality associated with common surgical procedures, such as coronary artery bypass grafting (CABG). However, the best methodological approach to improvement is under debate.
OBJECTIVE: To test an intervention to improve performance of CABG surgery.
DESIGN AND SETTING: Quality improvement project based on baseline (July 1, 1995-June 30, 1996) and follow-up (July 1-December 31, 1998) performance measurements from medical record review for all 20 Alabama hospitals that provided CABG surgery.
PATIENTS: Medicare patients discharged after CABG surgery in Alabama (n = 5784), a comparison state (n = 3214), and a national sample (n = 3758).
INTERVENTION: Confidential hospital-specific performance feedback and assistance with multimodal improvement interventions, including the option to share relevant experience with peers.
MAIN OUTCOME MEASURES: Duration of intubation, reintubation rate, aspirin therapy at discharge, use of the internal mammary artery (IMA), hospital readmission rate, and risk-adjusted in-hospital mortality.
RESULTS: Proportion of extubation within 6 hours increased from 9% to 41% in Alabama, decreased from 40% to 39% in the comparison state, and increased from 12% to 25% in the national sample. Use of IMA increased from 73% to 84%, 48% to 55%, and 74% to 81%, respectively, in the 3 samples, but aspirin use increased only in Alabama (from 88% to 92%). The amount of improvement in all 3 of these process measures was greater in Alabama than in the other samples (IMA use for Alabama vs comparison state was P =.001 and for Alabama vs national sample, P =.02; and P<.001 for all other comparisons). Risk-adjusted mortality decreased in Alabama (4.9% to 2.9%), but this decrease was not statistically significantly different from mortality changes in the other groups (odds ratio, 0.76; 95% confidence interval, 0.54-1.07 vs national sample).
CONCLUSION: Confidential peer-based regional performance feedback and process-oriented analysis of shared experience are associated with some improvement in quality of care for patients who underwent CABG surgery.
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Citation: JAMA. 2001 Jun 20;285(23):3003-10.
Holman, William L.; Allman, Richard M.; Sansom, Monique; Kiefe, Catarina I.; Peterson, Eric D.; Anstrom, Kevin J.; Sankey, Steadman S.; Hubbard, Steve G.; and Sherrill, Robert G., "Alabama coronary artery bypass grafting project: results of a statewide quality improvement initiative" (2001). Quantitative Health Sciences Publications and Presentations. 107.