The combined effect of public profiling and quality improvement efforts on heart failure management.
BACKGROUND
A before-and-after study was conducted to examine the combined effect of public profiling and quality improvement activities on management of heart failure (HF) in the hospital setting.


METHODS
Thirty-one hospitals in southeastern Michigan participated in this profiling and quality improvement study. One hospital closed after the baseline measurement. Two quality indicators were developed to evaluate the key processes of HF care, and one profiling indicator was designed for public profiling. The baseline results of the profiling indicator were publicly released. The individual hospitals were identified in the profiling report by name as "having statistically higher (or lower) rates than average." Remeasurement results were compared to the baseline results by using t-tests for the individual hospitals and all 30 hospitals as an aggregate.


RESULTS
Two-thirds of the hospitals improved ejection fraction documentation; the aggregate result improved 5.4 percentage points (p < 0.05). No change was observed in the aggregate measure of prescribing angiotensin-converting enzyme inhibitors (ACEIs) to eligible HF patients at discharge. Hospitals with low baseline rates made improvement in ACEI use at discharge, but those with good baseline performance tended to decline in performance. There was a 2.2 percentage point increase (p < 0.05) in the profiling indicator.


CONCLUSIONS
There seemed to be differential impacts of interventions across indicators and hospitals. Public profiling may have the most positive impact on hospitals with low performance at baseline. Maintaining the baseline good practice was a struggle for hospitals with relatively high baseline rates.
Pai
Chih-Wen
CW
University of Michigan Medical School, M7325B Medical Science Bldg 1, Box 0624, 1301 Catherine St, Ann Arbor, MI 48109, USA. cwpai@umich.edu
Finnegan
Geriann K
GK
Satwicz
Martha J
MJ
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D016507:Cardiology Service, Hospital / Q000145:classification / Q000592:standards*; D004636:Emergency Service, Hospital / Q000145:classification / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000145:classification / Q000628:therapy*; D006801:Humans; D033181:Information Dissemination; D008297:Male; D006278:Medicare; D008824:Michigan; D008875:Middle Aged; D011366:Professional Review Organizations; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013318:Stroke Volume; D017749:Total Quality Management / Q000458:organization & administration*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors