| Alabama coronary artery bypass grafting project: results of a statewide quality improvement initiative. | |
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MedLine Citation:
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PMID: 11410099 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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W L Holman; R M Allman; M Sansom; C I Kiefe; E D Peterson; K J Anstrom; S S Sankey; S G Hubbard; R G Sherrill; |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 285 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 2001 Jun |
Date Detail:
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Created Date: 2001-06-18 Completed Date: 2001-07-12 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 3003-10 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of Alabama School of Medicine, 703 S 19th St, ZRB 719, Birmingham, AL 35294-0007, USA. wholman@its.uab.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Alabama / epidemiology Coronary Artery Bypass / standards*, statistics & numerical data Female Hospital Mortality Humans Logistic Models Male Middle Aged Outcome and Process Assessment (Health Care)* Professional Review Organizations Statistics, Nonparametric Surgery Department, Hospital / standards* Survival Analysis Total Quality Management* United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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500-96-P605//PHS HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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