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