Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions.
BACKGROUND
The objective of this study was to evaluate the association of a continuous quality improvement program with practice and outcome variations of percutaneous coronary intervention (PCI).


RESULTS
Data on consecutive PCI were collected in a consortium of 5 hospitals; 3731 PCIs reflected care provided at baseline (January 1, 1998, to December 31, 1998), and 5901 PCIs reflected care provided after implementation of a continuous quality improvement intervention (January 1, 2002, to December 31, 2002). The intervention included feedback on outcomes, working group meetings, site visits, selection of quality indicators, and use of bedside tools for quality improvement and risk assessment. Postintervention data were compared with baseline and with 10,287 PCIs from 7 hospitals added to the consortium in 2002. Quality indicators included use of preprocedural aspirin or clopidogrel, use of glycoprotein IIb/IIIa receptor blockers and postprocedural heparin, and amount of contrast media per case. Outcomes selected included emergency CABG, contrast nephropathy, myocardial infarction, stroke, transfusion, and in-hospital death. Compared with baseline and the control group, the intervention group at follow-up had higher use of preprocedural aspirin and glycoprotein IIb/IIIa blockers, lower use of postprocedural heparin, and a lower amount of contrast media per case (P<0.05). These changes were associated with lower rates of transfusions, vascular complications, contrast nephropathy, stroke, transient ischemic attack, and combined end points (all P<0.05).


CONCLUSIONS
Our nonrandomized, observational data suggest that implementation of a regional continuous quality improvement program appears to be associated with enhanced adherence to quality indicators and improved outcomes of PCI. A randomized clinical trial is needed to determine whether this is a "causal" or a "casual" relationship.
Moscucci
Mauro
M
Division of Cardiology, Blue Cross Blue Shield of Michigan Cardiovascular Consortium Coordinating Center, University of Michigan, Ann Arbor, Michigan, USA. Moscucci@umich.edu
Rogers
Eva Kline
EK
Montoye
Cecelia
C
Smith
Dean E
DE
Share
David
D
O'Donnell
Michael
M
Maxwell-Eward
Ann
A
Meengs
William L
WL
De Franco
Anthony C
AC
Patel
Kirit
K
McNamara
Richard
R
McGinnity
John G
JG
Jani
Sandeep M
SM
Khanal
Sanjaya
S
Eagle
Kim A
KA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D000925:Anticoagulants / Q000627:therapeutic use; D003287:Contrast Media; D003625:Data Collection; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D016896:Treatment Outcome
D000925:Anticoagulants; D003287:Contrast Media; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin