on March 16, 2009
Published online before print March 16, 2009, doi: 10.1161/CIRCULATIONAHA.108.764613
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Submitted on January 5, 2008
From the Virginia Chapter, American College of Cardiology, Charlottesville, Va (J.E.B., C.M.V.); Virginia Health Quality Center, Glen Allen (E.R., F.S., S.C., J.L., S.G.); Department of Biostatistics, Virginia Commonwealth University, Richmond (L.T.); Division of Cardiology, Northwestern University Medical School, Chicago, Ill (R.O.B.); and Sentara Healthcare, Norfolk, Va (J.B.). * To whom correspondence should be addressed. E-mail: jebrush{at}earthlink.net.
Background—To enhance quality improvement, we created a unique statewide collaboration among 3 organizations: the Virginia Health Quality Center (Virginia's Medicare Quality Improvement Organization), the American College of Cardiology, and the American Heart Association. The goal was to improve discharge measures for acute myocardial infarction and heart failure. Methods and Results—In 2004, 29 hospitals participated in the collaborative initiative. Using Medicare data submitted from 2004 through the second quarter of 2006, we analyzed adherence to individual discharge measures and all-or-none appropriate care measures for acute myocardial infarction, heart failure, and both. To control for differences in hospital characteristics, we were able to match 21 of the participating hospitals with 21 similar nonparticipating hospitals. In this paired analysis, the total appropriate care measure increased from 61% to 77% in participating hospitals compared with an increase from 51% to 60% in nonparticipating hospitals (P<0.0001). A generalized linear mixed model examining the full data set at the patient level failed to show a clear advantage among participating hospitals. Participating hospitals had higher baseline rates for most quality measures, suggesting a possible effect of a prior collaborative. Further analysis of only hospitals that participated in a prior collaborative showed that participants in the current collaborative initiative had higher rates of improvement for 7 of 10 quality measures and appropriate care measures for heart failure, acute myocardial infarction, or both (all P<0.05). Conclusions—We report a unique collaboration of a Medicare Quality Improvement Organization and 2 national organizations to address quality of care for acute myocardial infarction and heart failure. A composite measure of quality (the total appropriate care measure) improved more in the participating hospitals during the timeframe of the intervention, although the greater improvement in this and other measures in the participating hospitals appeared to be dependent on participation in a prior collaborative initiative.
Accepted on January 21, 2009
A Statewide Collaborative Initiative to Improve the Quality of Care for Patients With Acute Myocardial Infarction and Heart Failure
John E. Brush Jr MD*,
Key words: heart failure • myocardial infarction • quality improvement • quality of health care
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