Impact of quality improvement activities on care for acute myocardial infarction.
OBJECTIVE
To examine the relationship between quality improvement activities reported to a peer review organization (PRO) and improvements in quality of care for patients with acute myocardial infarction (AMI).


METHODS
Time-series, comparative study of changes in care for AMI patients from 1992 to 1995 in hospitals reporting self-measurement or system changes compared to all other hospitals in the state.


METHODS
One-hundred and seventeen acute care hospitals in Iowa.


METHODS
Patients hospitalized with a principal diagnosis of AMI.


METHODS
Each hospital was given hospital-specific performance data, statewide aggregate data, and peer comparisons and was asked to provide the PRO with a plan to improve care for AMI patients.


METHODS
Chart audits were performed before and after the intervention. Quality of care was based on eight explicit process measures of the quality of AMI care (quality indicators).


RESULTS
Statewide, quality of care improved on five out of eight quality indicators. Of the 117 hospitals, 44 (38%) reported that they had implemented their own measurement activities or systematic improvements. These 44 hospitals showed significantly greater improvements than the other hospitals in use of aspirin during the hospitalization, recommendations for aspirin at discharge, and prescriptions for beta blockers at discharge.


CONCLUSIONS
While quality of care for AMI patients throughout Iowa is improving, the pace of improvement is greatest in hospitals reporting that they are measuring their own performance or implementing systematic changes in care processes. Continued efforts to encourage hospitals to implement these types of improvement activities are warranted.
Ellerbeck
E F
EF
Iowa Foundation for Medical Care, Des Moines 50266-7771, USA.
Kresowik
T F
TF
Hemann
R A
RA
Mason
P
P
Wiblin
R T
RT
Marciniak
T A
TA
D016507:Cardiology Service, Hospital / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007484:Iowa; D008137:Longitudinal Studies; D008485:Medical Audit; D009203:Myocardial Infarction / Q000628:therapy*; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D018024:Peer Review, Health Care; D011366:Professional Review Organizations; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D017749:Total Quality Management / Q000458:organization & administration*