| Economic and clinical outcomes of a physician-led continuous quality improvement intervention in the delivery of percutaneous coronary intervention. | |
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MedLine Citation:
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PMID: 16886887 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To compare clinical and economic outcomes associated with percutaneous coronary intervention (PCI) in cohorts before and after continuous quality improvement (CQI) was instituted. STUDY DESIGN: Observational study. METHODS: Clinical, angiographic, procedural, and outcome data on 1441 pre-CQI and 1760 post-CQI PCIs (performed in 1997 and 1998, respectively) were derived from an institutional PCI registry. Administrative data were used to estimate total procedural and postprocedural costs and length of stay (LOS). Logistic and generalized linear modeling was used to adjust in-hospital clinical and economic outcomes, respectively, for differences in patient characteristics. RESULTS: The 2 cohorts were similar in terms of age, sex, and rate of diabetes. Post-CQI patients more often received intracoronary stents, had urgent PCIs, had a history of prior PCI, and received glycoprotein IIb/IIIa inhibitors. Procedural success without in-hospital complications occurred in 90% of both cohorts and did not differ statistically in adjusted analyses. Compared with patients treated pre-CQI, those treated post-CQI had a reduced adjusted odds ratio for in-hospital death or any myocardial infarction (odds ratio = 0.66; 95% confidence interval = 0.46, 0.95). Models predicted a mean postprocedural LOS difference of 0.8 days (2.8 days pre-CQI vs 2.0 days post-CQI; P <.001) and an average post-CQI cost savings of $5430 (P <.001). CONCLUSION: Physician-led, multidisciplinary practice management efforts were successful at significantly reducing PCI-related costs in an era of rapid technological advances while maintaining and perhaps improving quality of care. |
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Authors:
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Charanjit S Rihal; Celia C Kamath; David R Holmes; M Katherine Reller; Stephanie S Anderson; Erin K McMurtry; Kirsten Hall Long |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of managed care Volume: 12 ISSN: 1088-0224 ISO Abbreviation: Am J Manag Care Publication Date: 2006 Aug |
Date Detail:
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Created Date: 2006-08-04 Completed Date: 2006-09-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9613960 Medline TA: Am J Manag Care Country: United States |
Other Details:
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Languages: eng Pagination: 445-52 Citation Subset: H |
Affiliation:
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Cardiac Catheterization Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. rihal@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / economics*, standards Cohort Studies Female Humans Leadership* Male Middle Aged Physicians* Total Quality Management / organization & administration* Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Am J Manag Care. 2006 Aug;12(8):429-30
[PMID:
16886885
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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