title: Effects of a statewide physician-led quality-improvement program on the quality of cardiac care.
abstract: BACKGROUND
  Several states have implemented mandatory public reporting of outcomes of cardiac revascularization procedures. Washington is the first to develop a nonmandatory, physician-led reporting program with public accountability and universal hospital participation. The purpose of this study was to determine whether quality improvement interventions resulted in the correction of data deficiencies and performance outliers for cardiac revascularization procedures.
  
  
  METHODS
  From 1999 through 2003, there were 18 hospitals with coronary bypass surgery and interventional cardiology programs and 12 with only the latter. All patients > or =18 years undergoing 24372 isolated coronary bypass surgeries and 59,656 percutaneous coronary interventions were included. After 1999 to 2001 data were analyzed in early 2002, the Clinical Outcomes Assessment Program implemented a 6-step quality-improvement intervention to measure and remeasure data quality, process compliance, and performance.
  
  
  RESULTS
  In 2003, 4 of the 18 surgery programs had 1 statistical outlier with respect to 4 performance measures, whereas 2 of 30 coronary intervention programs were mortality outliers. For bypass surgery, all programs maintained full compliance with program standards by adhering to timely and reliable submission of data, developing plans to address performance outliers, and demonstrating that outlier status did not persist from baseline to remeasurement. For coronary interventions, 1 program was a persistent outlier for mortality in 2002 and 2003.
  
  
  CONCLUSIONS
  The Clinical Outcomes Assessment Program has successfully monitored cardiac care patterns in Washington State over a 5-year period. Most hospitals that perform coronary revascularization procedures meet acceptable performance standards.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: J Richard
authors.initials: JR
authors.lastname: Goss
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Aldea
authors.forename: Miriam
authors.initials: M
authors.lastname: Marcus-Smith
authors.forename: Richard W
authors.initials: RW
authors.lastname: Whitten
authors.forename: Gilbert
authors.initials: G
authors.lastname: Johnston
authors.forename: Richard C
authors.initials: RC
authors.lastname: Phillips
authors.forename: Mark
authors.initials: M
authors.lastname: Reisman
authors.forename: Ann
authors.initials: A
authors.lastname: Kelley
authors.forename: Richard P
authors.initials: RP
authors.lastname: Anderson
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010820:Physicians; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D014861:Washington