This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (111)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

A Qualitative Study of Increasing -Blocker Use After Myocardial Infarction

Why Do Some Hospitals Succeed?

Elizabeth H. Bradley, PhD; Eric S. Holmboe, MD; Jennifer A. Mattera, MPH; Sarah A. Roumanis, RN; Martha J. Radford, MD; Harlan M. Krumholz, MD

JAMA. 2001;285:2604-2611.

Context  Based on evidence that -blockers can reduce mortality in patients with acute myocardial infarction (AMI), many hospitals have initiated performance improvement efforts to increase prescription of -blockers at discharge. Determination of the factors associated with such improvements may provide guidance to hospitals that have been less successful in increasing -blocker use.

Objectives  To identify factors that may influence the success of improvement efforts to increase -blocker use after AMI and to develop a taxonomy for classifying such efforts.

Design, Setting, and Participants  Qualitative study in which data were gathered from in-depth interviews conducted in March-June 2000 with 45 key physician, nursing, quality management, and administrative participants at 8 US hospitals chosen to represent a range of hospital sizes, geographic regions, and changes in -blocker use rates between October 1996 and September 1999.

Main Outcome Measures  Initiatives, strategies, and approaches to improve care for patients with AMI.

Results  The interviews revealed 6 broad factors that characterized hospital-based improvement efforts: goals of the efforts, administrative support, support among clinicians, design and implementation of improvement initiatives, use of data, and modifying variables. Hospitals with greater improvements in -blocker use over time demonstrated 4 characteristics not found in hospitals with less or no improvement: shared goals for improvement, substantial administrative support, strong physician leadership advocating -blocker use, and use of credible data feedback.

Conclusions  This study provides a context for understanding efforts to improve care in the hospital setting by describing a taxonomy for classifying and evaluating such efforts. In addition, the study suggests possible elements of successful efforts to increase -blocker use for patients with AMI.

Author Affiliations: Departments of Epidemiology and Public Health (Drs Bradley and Krumholz), Medicine (Dr Holmboe), and Section of Cardiovascular Medicine, Department of Medicine (Drs Radford and Krumholz), Yale University School of Medicine; and Yale-New Haven Hospital Center for Outcomes Research and Evaluation (Drs Radford and Krumholz, Mss Mattera and Roumanis), New Haven, Conn.

RELATED ARTICLE

May 23/30, 2001
JAMA. 2001;285(20):2655-2656.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hospital quality improvement in Ethiopia: a partnership-mentoring model
Bradley et al.
Int J Qual Health Care 2008;0:mzn042v1-8.
ABSTRACT | FULL TEXT  

Outcomes Research: Generating Evidence for Best Practice and Policies
Krumholz
Circulation 2008;118:309-318.
FULL TEXT  

Review: How Do Hospital Organizational Structure and Processes Affect Quality of Care?: A Critical Review of Research Methods
Hearld et al.
Med Care Res Rev 2008;65:259-299.
ABSTRACT  

Better Outcomes for Patients Treated at Hospitals That Participate in Clinical Trials
Majumdar et al.
Arch Intern Med 2008;168:657-662.
ABSTRACT | FULL TEXT  

A Randomized Trial of Direct-to-Patient Communication to Enhance Adherence to {beta}-Blocker Therapy Following Myocardial Infarction
Smith et al.
Arch Intern Med 2008;168:477-483.
ABSTRACT | FULL TEXT  

Promoting quality: the health-care organization from a management perspective
Glickman et al.
Int J Qual Health Care 2007;19:341-348.
ABSTRACT | FULL TEXT  

Performance Measures, Vaccinations, and Pneumonia Rates Among High-Risk Patients in Veterans Administration Health Care
Jha et al.
Am. J. Public Health 2007;97:2167-2172.
ABSTRACT | FULL TEXT  

Improving Patient Care by Linking Evidence-Based Medicine and Evidence-Based Management
Shortell et al.
JAMA 2007;298:673-676.
FULL TEXT  

An Evidence-Based Template for Implementation of Multidisciplinary Evidence-Based Practices in a Tertiary Hospital Setting
Kresse et al.
American Journal of Medical Quality 2007;22:148-163.
ABSTRACT  

The Role of Physicians and Certification Boards to Improve Quality
Holmboe and Cassel
American Journal of Medical Quality 2007;22:18-25.
ABSTRACT  

Diffusion of complex health innovations--implementation of primary health care reforms in Bosnia and Herzegovina
Atun et al.
Health Policy Plan 2007;22:28-39.
ABSTRACT | FULL TEXT  

The Impact of Unstable Angina Guidelines in the Triage of Emergency Department Patients with Possible Acute Coronary Syndrome.
Katz et al.
Med Decis Making 2006;26:606-616.
ABSTRACT  

Assessing the reliability of standardized performance indicators
Williams et al.
Int J Qual Health Care 2006;18:246-255.
ABSTRACT | FULL TEXT  

Qualitative Analysis of Mothers' Decision-Making About Vaccines for Infants: The Importance of Trust
Benin et al.
Pediatrics 2006;117:1532-1541.
ABSTRACT | FULL TEXT  

Effect of the Integrated Management of Childhood Illness strategy on health care quality in Morocco
Naimoli et al.
Int J Qual Health Care 2006;18:134-144.
ABSTRACT | FULL TEXT  

Achieving Rapid Door-To-Balloon Times: How Top Hospitals Improve Complex Clinical Systems
Bradley et al.
Circulation 2006;113:1079-1085.
ABSTRACT | FULL TEXT  

Continuous Quality Improvement in the Cardiac Catheterization Laboratory: Are the Benefits Worth the Cost and Effort?
Brindis and Dehmer
Circulation 2006;113:767-770.
FULL TEXT  

Achieving Door-to-Balloon Times That Meet Quality Guidelines: How Do Successful Hospitals Do It?
Bradley et al.
J Am Coll Cardiol 2005;46:1236-1241.
ABSTRACT | FULL TEXT  

Guideline-Based Standardized Care Is Associated With Substantially Lower Mortality in Medicare Patients With Acute Myocardial Infarction: The American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan
Eagle et al.
J Am Coll Cardiol 2005;46:1242-1248.
ABSTRACT | FULL TEXT  

The impact of standardized stroke orders on adherence to best practices
California Acute Stroke Pilot Registry (CASPR) Inv
Neurology 2005;65:360-365.
ABSTRACT | FULL TEXT  

American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management: American Pain Society Quality of Care Task Force
Gordon et al.
Arch Intern Med 2005;165:1574-1580.
ABSTRACT | FULL TEXT  

Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002-2004
Williams et al.
NEJM 2005;353:255-264.
ABSTRACT | FULL TEXT  

Care in U.S. Hospitals -- The Hospital Quality Alliance Program
Jha et al.
NEJM 2005;353:265-274.
ABSTRACT | FULL TEXT  

Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, A Cluster Randomized Trial
Beck et al.
JAMA 2005;294:309-317.
ABSTRACT | FULL TEXT  

Adherence to Heart Failure Quality-of-Care Indicators in US Hospitals: Analysis of the ADHERE Registry
Fonarow et al.
Arch Intern Med 2005;165:1469-1477.
ABSTRACT | FULL TEXT  

Increasing Value: A Research Agenda for Addressing the Managerial and Organizational Challenges Facing Health Care Delivery in the United States
Shortell
Med Care Res Rev 2004;61:12S-30S.
ABSTRACT  

Optimising care of acute coronary syndromes in three Australian hospitals
Scott et al.
Int J Qual Health Care 2004;16:275-284.
ABSTRACT | FULL TEXT  

Hospital Quality Improvement Activities and the Effects of Interventions on Pneumonia: A Multistate Study of Medicare Beneficiaries
Weingarten et al.
American Journal of Medical Quality 2004;19:157-165.
ABSTRACT  

Provider and Hospital Characteristics Associated With Geographic Variation in the Evaluation and Management of Elderly Patients With Heart Failure
Havranek et al.
Arch Intern Med 2004;164:1186-1191.
ABSTRACT | FULL TEXT  

Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge
Butler et al.
J Am Coll Cardiol 2004;43:2036-2043.
ABSTRACT | FULL TEXT  

Reply
Johnson and Cujec
J Am Coll Cardiol 2004;43:1333-1334.
FULL TEXT  

The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Nonclinical Managers
Fetterolf and West
American Journal of Medical Quality 2004;19:48-55.
ABSTRACT  

Data feedback efforts in quality improvement: lessons learned from US hospitals
Bradley et al.
Qual Saf Health Care 2004;13:26-31.
ABSTRACT | FULL TEXT  

Organizing Regional Perinatal Quality Improvement: Global Considerations and Local Implementation
Wirtschafter and Powers
NeoReviews 2004;5:e50-59.
FULL TEXT  

Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada
Johnson et al.
J Am Coll Cardiol 2003;42:1438-1445.
ABSTRACT | FULL TEXT  

The Depression Care Manager and Mental Health Specialist as Collaborators Within Primary Care
Oxman et al.
AJGP 2003;11:507-516.
ABSTRACT | FULL TEXT  

Use of Continuous Quality Improvement to Increase Use of Process Measures in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial
Ferguson et al.
JAMA 2003;290:49-56.
ABSTRACT | FULL TEXT  

Challenges and opportunities in quantifying the quality of care for acute myocardial infarction: Summary from the acute myocardial infarction working group of the American heart association/American college of cardiology first scientific forum on quality of care and outcomes research in cardiovascular disease and stroke
Spertus et al.
J Am Coll Cardiol 2003;41:1653-1663.
FULL TEXT  

Challenges and Opportunities in Quantifying the Quality of Care for Acute Myocardial Infarction: Summary From the Acute Myocardial Infarction Working Group of the American Heart Association/American College of Cardiology First Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke
Spertus et al.
Circulation 2003;107:1681-1691.
FULL TEXT  

Pharmacist Led, Primary Care-Based Disease Management Improves Hemoglobin Aic in High-Risk Patients With Diabetes
Rothman et al.
American Journal of Medical Quality 2003;18:51-58.
ABSTRACT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

Outpatient adherence to beta-blocker therapy after acute myocardial infarction
Butler et al.
J Am Coll Cardiol 2002;40:1589-1595.
ABSTRACT | FULL TEXT  

Quality Control, Enterprise Liability, and Disintermediation in Managed Care
Jacobi and Huberfeld
J Law Med Ethics 2001;29:305-322.