 |
|
Alabama Coronary Artery Bypass Grafting Project
Results of a Statewide Quality Improvement Initiative
William L. Holman, MD;
Richard M. Allman, MD;
Monique Sansom, BSN;
Catarina I. Kiefe, MD,PhD;
Eric D. Peterson, MD,MPH;
Kevin J. Anstrom, MD;
Steadman S. Sankey, PhD;
Steve G. Hubbard, MD;
Robert G. Sherrill, MD;
for the Alabama CABG Study Group
JAMA. 2001;285:3003-3010.
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.
Author Affiliations: Departments of Surgery and Medicine, University of Alabama at Birmingham (Drs Holman, Allman, and Kiefe); the Alabama Quality Assurance Foundation (Ms Sansom, and Drs Allman, Kiefe, Sankey, and Sherrill); Birmingham Veterans Affairs Medical Center (Drs Holman, Allman, and Kiefe); East Alabama Medical Center, Opelika, (Dr Hubbard); Duke University Medical Center, Durham, NC (Drs Peterson and Anstrom); and the University of Alabama at Birmingham's Center for Outcomes and Effectiveness Research and Education (Dr Kiefe).
RELATED ARTICLE
June 20, 2001
JAMA. 2001;285(23):3035-3036.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Do cardiac surgery report cards reduce mortality? Assessing the evidence.
Epstein
Med Care Res Rev 2006;63:403-426.
ABSTRACT
Effects of a Quality Improvement Collaborative on the Outcome of Care of Patients with HIV Infection: The EQHIV Study
Landon et al.
ANN INTERN MED 2004;140:887-896.
ABSTRACT
| FULL TEXT
Outcomes of early extubation after bypass surgery in the elderly
Guller et al.
Ann. Thorac. Surg. 2004;77:781-788.
ABSTRACT
| FULL TEXT
Do hospitals with low mortality rates in coronary artery bypass also perform well in valve replacement?
Goodney et al.
Ann. Thorac. Surg. 2003;76:1131-1137.
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
American College of Cardiology/American Heart Association Clinical Practice Guidelines: Part II: Evolutionary Changes in a Continuous Quality Improvement Project
Gibbons et al.
Circulation 2003;107:3101-3107.
FULL TEXT
Liberation From Mechanical Ventilation Following Heart Surgery
Sivak
SEMIN CARDIOTHORAC VASC ANESTH 2002;6:203-217.
ABSTRACT
Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: Room for process improvement?
Ferguson et al.
J. Thorac. Cardiovasc. Surg. 2002;123:869-880.
ABSTRACT
| FULL TEXT
The Effect of Comorbid Illness on Mortality Outcomes in Cardiac Surgery
Clough et al.
Arch Surg 2002;137:428-433.
ABSTRACT
| FULL TEXT
A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute
Ferguson et al.
Ann. Thorac. Surg. 2002;73:480-489.
ABSTRACT
| FULL TEXT
|
