The "Toward Excellence in Care" program: a statewide indicator project.
BACKGROUND
The "Toward Excellence in Care" program was launched by Connecticut hospitals and physicians in 1988 to develop and use quality-of-care indicators for use in quality improvement.


METHODS
Data came primarily from the Connecticut Health Information Management and Exchange (CHIME) database, which contains discharge abstract information, UB (uniform billing)-82 information, and additional data elements, for all of Connecticut's 34 acute care hospitals. Linkages also occur with the state mortality database, the trauma registry, and with admission/discharge data within and across Connecticut hospitals. The "Toward Excellence in Care" program staff help the hospital use the data on indicator reports for quality improvement.


RESULTS
On receiving a report on care for patients with acute myocardial infarction (AMI) a program representative summarized opportunities for improvement. The data were then disseminated to both the cardiology and the hospitalwide quality improvement staffs. Cardiologists conducted chart review on 100% of patients included in the last time-frame on the report (for example, fiscal year 1991). The quality improvement professional documented the system of care for an AMI patient. Recommended actions included adoption of a policy for emergency department administration of thrombolytic therapy before a cardiology consultation, and modification of the postcoronary care program.


CONCLUSIONS
Progress in addressing four challenges-easing the burden of data collection on the hospitals, maximizing acceptance of information by hospitals and physicians, risk adjusting data to permit comparison of outcomes, and facilitating understanding of reports--is reflected in expanding use of the "Toward Excellence in Care" program.
Lynch
J T
JT
Connecticut Hospital Research and Education Foundation, Inc, Wallingford 06492-0090.
Mattie
A S
AS
Shevchenko
I P
IP
Reed-Fourquet
L L
LL
D003219:Confidentiality; D003237:Connecticut; D003625:Data Collection; D016208:Databases, Factual; D006292:Health Priorities; D006761:Hospitals / Q000592:standards*; D008498:Medical Record Linkage; D009937:Organizational Objectives; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012308:Risk Management / Q000458:organization & administration; D012954:Societies, Hospital; D013223:Statistics as Topic