Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative.
OBJECTIVE
This report describes the first round of results for Phase II of the Alabama CABG Project, a regional quality improvement initiative.


METHODS
Charts submitted by all hospitals in Alabama performing CABG (ICD-9 codes 36.10-36.20) were reviewed by a Clinical Data Abstraction Center (CDAC) (preintervention 1999-2000; postintervention 2000-2001). Variables that described quality in Phase I were abstracted for Phase II and data describing the new variables of beta-blocker use and lipid management were collected. Data samples collected onsite by participating hospitals were used for rapid cycle improvement in Phase II.


RESULTS
CDAC data (n = 1927 cases in 1999; n = 2001 cases in 2000) showed that improvements from Phase I in aspirin prescription, internal mammary artery use, and duration of intubation persisted in Phase II. During Phase II, use of beta-blockers before, during, or after CABG increased from 65% to 76% of patients (P < 0.05). Appropriate lipid management, an aggregate variable, occurred in 91% of patients before and 91% after the educational intervention. However, there were improvements in 3 of 5 subcategories for lipid management (documenting a lipid disorder [52%-57%], initiating drug therapy [45%-53%], and dietary counseling [74%-91%]; P < 0.05).


CONCLUSIONS
In Phase II, this statewide process-oriented quality improvement program added two new measures of quality. Achievements of quality improvement from Phase I persisted in Phase II, and improvements were seen in the new variables of lipid management and perioperative use of beta-blockers.
Holman
William L
WL
Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA. wholman@its.uab.edu
Sansom
Monique
M
Kiefe
Catarina I
CI
Peterson
Eric D
ED
Hubbard
Steve G
SG
Delong
James F
JF
Allman
Richard M
RM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D001241:Aspirin / Q000627:therapeutic use; D019985:Benchmarking; D016507:Cardiology Service, Hospital / Q000592:standards*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality* / Q000592:standards*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital / Q000592:standards*; D016019:Survival Analysis; D017749:Total Quality Management / Q000379:methods*
D000319:Adrenergic beta-Antagonists; D001241:Aspirin