The effects of quality improvement interventions on inhospital mortality after acute myocardial infarction.
OBJECTIVE
To evaluate the effects of quality improvement interventions on inhospital mortality after admission for acute myocardial infarction (AMI).


METHODS
Before-and-after study (with concurrent controls) based on hospital discharge data from a routinely maintained, administrative database.


METHODS
All Queensland public hospitals, July 1991 - June 1999.


METHODS
Patients with AMI admitted through the emergency department.


METHODS
Development and promulgation of clinical practice guidelines at one hospital, combined with regular audit and feedback, commencing November 1995.


METHODS
Inhospital mortality (adjusted for age, sex and comorbidities) for four-year periods before (1991-92 to 1994-95) and after (1995-96 to 1998-99) initiation of quality improvement interventions.


RESULTS
Before the intervention, the adjusted odds ratio (OR) for inhospital death at the intervention hospital was about the same as at other public hospitals (adjusted OR, 0.99; 95% CI, 0.80-1.24), but was more than 40% lower after the intervention (adjusted OR, 0.59; 95% Cl, 0.45-0.78). After the intervention, the risk of death at the intervention hospital was lower compared with hospitals with cardiologists as admitting practitioners (adjusted OR, 0.63; 95% CI, 0.48-0.83), with onsite revascularisation facilities (adjusted OR, 0.66; 95% CI, 0.49-0.88), and with large numbers (> or = 250 per year) of annual admissions of patients with AMI (adjusted OR, 0.72; 95% CI, 0.54-0.97).


CONCLUSIONS
Quality improvement interventions lower the risk of inhospital death in patients with AMI. Implementation of such interventions in all hospitals may confer a risk of death lower than that achieved by admitting all patients under the care of cardiologists, or to hospitals with revascularisation facilities or a high volume of admissions of patients with AMI.
Scott
I A
IA
Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, QLD. ian_scott@health.qld.gov.au
Coory
M D
MD
Harper
C M
CM
D016507:Cardiology Service, Hospital / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D016015:Logistic Models; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011793:Queensland / Q000453:epidemiology