What are hospitals doing to increase beta-blocker use?
BACKGROUND
Despite the many proposed methods for improving quality, little is known about which methods are being applied in practice across the United States or their perceived effectiveness.


METHODS
A descriptive, cross-sectional analysis of data from a telephone survey of quality improvement staff in 234 randomly selected hospitals participating in the National Registry of Myocardial Infarction was conducted to examine the prevalence and perceived effectiveness of various quality improvement interventions directed at increasing beta-blocker use after acute myocardial infarction.


RESULTS
The mean and median number of quality improvement interventions directed at beta-blocker use in the past 4 years was 5.0 per hospital. The most commonly reported effort was performance reporting about beta-blocker use (87.9%), although only 26.7% used physician-specific performance reporting. More than half the hospitals implemented clinical pathways (58.1%), standing orders (56.8%), or care coordinators (50.4%). Care coordinators (63.4%) and computer support systems (61.6%) were most frequently rated as "very effective." Clinical pathways (24.2%), counseling physicians who had poor performance (26.9%), and reminder forms (23.0%) were most frequently rated as not effective.


CONCLUSIONS
Substantial variation in the types of quality improvement efforts implemented to increase beta-blocker use and perceived effectiveness were evident.
Bradley
Elizabeth H
EH
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.
Holmboe
Eric S
ES
Wang
Yongfei
Y
Herrin
Jeph
J
Frederick
Paul D
PD
Mattera
Jennifer A
JA
Roumanis
Sarah A
SA
Radford
Martha J
MJ
Krumholz
Harlan M
HM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D019985:Benchmarking; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006761:Hospitals / Q000145:classification / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000517:prevention & control; D011785:Quality Assurance, Health Care / Q000379:methods*; D012042:Registries
D000319:Adrenergic beta-Antagonists