title: Data feedback and clinical process improvement in acute myocardial infarction.
abstract: BACKGROUND
  Numerous reports have shown substantial undertreatment of acute myocardial infarction (AMI). The goal of this intervention study was to improve both the acute and discharge care of patients with AMI. Thirty-eight Tenet hospitals participated in a cardiac improvement collaborative called the Partnership for Change. Interventions included the implementation of a computerized concurrent data feedback system and the organization, staffing, and deployment of performance improvement teams at each hospital.
  
  
  METHODS
  Data were collected on 11 394 patients with AMI between January 1, 2001, and June 30, 2002. We calculated rates of treatments including aspirin (first 24 hours and at discharge), beta-blocking agent (first 24 hours and at discharge), reperfusion using thrombolysis (first 30 minutes) or percutaneous intervention (first 2 hours), angiotensin-converting enzyme inhibitor (at discharge), smoking cessation counseling (during hospital stay), and referral to a cardiac rehabilitation program (at discharge).
  
  
  RESULTS
  Statistically significant increases were seen for all indicators. Aspirin use during the first 24 hours increased from 86.4% to 96.5% and use at discharge increased from 70.0% to 87.4%. The use of beta-blocking agents during the first 24 hours increased from 51.4% to 88.4% and use at discharge increased from 62.4% to 83.5%. Reperfusion during the first 2 hours increased from 25.9% to 35.3%. Discharge use of angiotensin-converting enzyme inhibitors increased from 29.3% to 43.3%. Smoking cessation counseling increased from 35.1% to 80.6%. Referral to a cardiac rehabilitation program increased from 16.9% to 41.7%. All P values were <.001.
  
  
  CONCLUSIONS
  The implementation of a rapid-cycle computerized concurrent data feedback system along with on-site process improvement teams was associated with a substantial increase in the use of both acute and discharge treatments for AMI.
authors.affiliation: Clinical Quality Department, Tenet Healthcare Corporation, Dallas, Tex 75240, USA. huiling.zhang@tenethealth.com
authors.forename: Huiling
authors.initials: H
authors.lastname: Zhang
authors.forename: Julia A
authors.initials: JA
authors.lastname: Alexander
authors.forename: Josiah
authors.initials: J
authors.lastname: Luttrell
authors.forename: Gerald T
authors.initials: GT
authors.lastname: O'Connor
authors.forename: Jennifer
authors.initials: J
authors.lastname: Daley
authors.forename: Martin
authors.initials: M
authors.lastname: Paris
mesh_terms: D000368:Aged; D005246:Feedback; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014481:United States