title: A qualitative study of increasing beta-blocker use after myocardial infarction: Why do some hospitals succeed?
abstract: BACKGROUND
  Based on evidence that beta-blockers can reduce mortality in patients with acute myocardial infarction (AMI), many hospitals have initiated performance improvement efforts to increase prescription of beta-blockers at discharge. Determination of the factors associated with such improvements may provide guidance to hospitals that have been less successful in increasing beta-blocker use.
  
  
  OBJECTIVE
  To identify factors that may influence the success of improvement efforts to increase beta-blocker use after AMI and to develop a taxonomy for classifying such efforts.
  
  
  METHODS
  Qualitative study in which data were gathered from in-depth interviews conducted in March-June 2000 with 45 key physician, nursing, quality management, and administrative participants at 8 US hospitals chosen to represent a range of hospital sizes, geographic regions, and changes in beta-blocker use rates between October 1996 and September 1999.
  
  
  METHODS
  Initiatives, strategies, and approaches to improve care for patients with AMI.
  
  
  RESULTS
  The interviews revealed 6 broad factors that characterized hospital-based improvement efforts: goals of the efforts, administrative support, support among clinicians, design and implementation of improvement initiatives, use of data, and modifying variables. Hospitals with greater improvements in beta-blocker use over time demonstrated 4 characteristics not found in hospitals with less or no improvement: shared goals for improvement, substantial administrative support, strong physician leadership advocating beta-blocker use, and use of credible data feedback.
  
  
  CONCLUSIONS
  This study provides a context for understanding efforts to improve care in the hospital setting by describing a taxonomy for classifying and evaluating such efforts. In addition, the study suggests possible elements of successful efforts to increase beta-blocker use for patients with AMI.
authors.affiliation: Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA.
authors.forename: E H
authors.initials: EH
authors.lastname: Bradley
authors.forename: E S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: J A
authors.initials: JA
authors.lastname: Mattera
authors.forename: S A
authors.initials: SA
authors.lastname: Roumanis
authors.forename: M J
authors.initials: MJ
authors.lastname: Radford
authors.forename: H M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D016507:Cardiology Service, Hospital / Q000592:standards*; D004363:Drug Utilization; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D017749:Total Quality Management; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists