Document Detail

Alabama coronary artery bypass grafting project: results of a statewide quality improvement initiative.
MedLine Citation:
PMID:  11410099     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  285     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-18     Completed Date:  2001-07-12     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3003-10     Citation Subset:  AIM; IM    
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MeSH Terms
Alabama / epidemiology
Coronary Artery Bypass / standards*,  statistics & numerical data
Hospital Mortality
Logistic Models
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
500-96-P605//PHS HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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