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(Circulation. 2006;113:814-822.)
© 2006 American Heart Association, Inc.

Health Services and Outcomes Research

Association of a Continuous Quality Improvement Initiative With Practice and Outcome Variations of Contemporary Percutaneous Coronary Interventions

Mauro Moscucci, MD; Eva Kline Rogers, RN, MS; Cecelia Montoye, RN, MN; Dean E. Smith, MS, PhD; David Share, MD, MPH; Michael O’Donnell, MD; Ann Maxwell-Eward, PhD; William L. Meengs, MD; Anthony C. De Franco, MD; Kirit Patel, MD; Richard McNamara, MD; John G. McGinnity, MS, PA-C; Sandeep M. Jani, MPH; Sanjaya Khanal, MD; Kim A. Eagle, MD, for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

From the University of Michigan, Division of Cardiology, Blue Cross Blue Shield of Michigan Cardiovascular Consortium Coordinating Center, Ann Arbor (M.M., D.S., E.K.R., C.M., S.M.J., K.A.E.); Center for Health Care Quality and Evaluative Studies, Blue Cross and Blue Shield of Michigan, Detroit (D.S.); St Joseph Mercy Hospital, Ann Arbor, Mich (M.O.); Spectrum Health, Grand Rapids, Mich (A.M.E., R.M.N.); Northern Michigan Hospital, Petoskey (W.L.M.); Harper Hospital, Detroit, Mich (J.G.M.); Henry Ford Hospital, Detroit, Mich (S.K.); McLaren Regional Medical Center, Flint, Mich (A.C.D.); and St Joseph Hospital, Pontiac, Mich (K.P.).

Correspondence to Mauro Moscucci, MD, University of Michigan Health System, University Hospital, TC B1-226, 1500 E Medical Center Dr, Ann Arbor, Michigan 48103-0311. E-mail Moscucci{at}umich.edu

Received February 9, 2005; revision received November 8, 2005; accepted November 14, 2005.

Background— The objective of this study was to evaluate the association of a continuous quality improvement program with practice and outcome variations of percutaneous coronary intervention (PCI).

Methods and Results— Data on consecutive PCI were collected in a consortium of 5 hospitals; 3731 PCIs reflected care provided at baseline (January 1, 1998, to December 31, 1998), and 5901 PCIs reflected care provided after implementation of a continuous quality improvement intervention (January 1, 2002, to December 31, 2002). The intervention included feedback on outcomes, working group meetings, site visits, selection of quality indicators, and use of bedside tools for quality improvement and risk assessment. Postintervention data were compared with baseline and with 10 287 PCIs from 7 hospitals added to the consortium in 2002. Quality indicators included use of preprocedural aspirin or clopidogrel, use of glycoprotein IIb/IIIa receptor blockers and postprocedural heparin, and amount of contrast media per case. Outcomes selected included emergency CABG, contrast nephropathy, myocardial infarction, stroke, transfusion, and in-hospital death. Compared with baseline and the control group, the intervention group at follow-up had higher use of preprocedural aspirin and glycoprotein IIb/IIIa blockers, lower use of postprocedural heparin, and a lower amount of contrast media per case (P<0.05). These changes were associated with lower rates of transfusions, vascular complications, contrast nephropathy, stroke, transient ischemic attack, and combined end points (all P<0.05).

Conclusions— Our nonrandomized, observational data suggest that implementation of a regional continuous quality improvement program appears to be associated with enhanced adherence to quality indicators and improved outcomes of PCI. A randomized clinical trial is needed to determine whether this is a "causal" or a "casual" relationship.

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