Abstract 19370: Are the Benefits of Quality-of-Care Improvement Programs in Acute Coronary Syndromes Maintained Once the Intervention Is Over?
Objective: It has been demonstrated that participation in quality improvement programs increases hospital adherence to evidence-based recommendations for the management of patients with non-ST elevation acute coronary syndromes (NSTE-ACS). However, it is uncertain whether this effect is maintained, and for how long, after the intervention is over.
Methods and Results: Our department (cardiology department in a tertiary university center) participated in the intervention arm of a multicenter, international trial assessing the effect of a quality-of-care improvement program in NSTE-ACS during 2008. Program implementation led to significant improvements in several indicators of care quality at the end of the trial. In the present study, we analyzed whether these effects were maintained throughout the following year, when no intervention was applied. A total of 303 consecutive NSTE-ACS patients ≤80 years, admitted from our Emergency Department and with either ECG changes, abnormal troponins, or both, were included in the active phase of the study and 271 on the next year. Our local performance regarding the main objetives of the trial before, immediately after, and during the first and second semesters after having applied the quality improvement program was as follows: rates of coronary angiography within 72 h after admission, 61, 59, 59 and 61%, respectively; use of iv. or sc. anticoagulant therapy, 90, 88, 92 and 92%; use of statins during hospitalization, 77, 97, 92 and 89%; prescription of beta-blocking agents at discharge in patients with ejection fraction (EF) ≤50%, 78, 82, 78 and 64%; ACE inhibitors or angiotensin-2 receptor blockers at discharge if EF ≤40%, diabetes, hypertension or chronic renal failure, 75, 91, 73 and 68%; loading dose of clopidogrel within 24 h after admission, 33, 57, 41 and 44%; prescription of clopidogrel at discharge, 57, 66, 69 and 68%.
Conclusions: The rates of fulfillment of care quality measures after the quality improvement program was over frequently declined as time progressed. These results suggest that quality-of-care improvement initiatives should not rely on isolated actions but instead require continuous, or at least periodic, monitoring and intervention.
- Acute coronary syndromes
- Disease management
- Quality assessment
- Myocardial infarction, NSTEMI
- Patient care
- © 2010 by American Heart Association, Inc.