title: Improved adherence to Swedish national guidelines for acute myocardial infarction: the Quality Improvement in Coronary Care (QUICC) study.
abstract: BACKGROUND
  The adherence to evidence-based treatment guidelines for acute myocardial infarction (AMI) is still suboptimal. Therefore, we designed a study to evaluate the effects of a collaborative quality improvement (QI) intervention on the adherence to AMI guidelines. The intervention used a national web-based quality registry to generate local and regular real-time performance feedback.
  
  
  METHODS
  A 12-month baseline measurement of the adherence rates was retrospectively collected, comprising the period July 1, 2001, through June 30, 2002. During the intervention period of November 1, 2002, through April 30, 2003, multidisciplinary teams from 19 nonrandomized intervention hospitals were subjected to a multifaceted QI-oriented intervention. Another 19 hospitals, unaware of their status as controls, were matched to the intervention hospitals. During the postintervention measurement period of May 1, 2003, through April 30, 2004, a total of 6726 consecutive patients were included at the intervention (n = 3786) and control (n = 2940) hospitals. The outcome measures comprised 5 Swedish national guideline-derived quality indicators, compared between baseline and postintervention levels in the control and QUICC intervention hospitals.
  
  
  RESULTS
  In the control and QI intervention hospitals, the mean absolute increase of patients receiving angiotensin-converting enzyme inhibitors was 1.4% vs 12.6% (P = .002), lipid-lowering therapy 2.3% vs 7.2% (P = .065), clopidogrel 26.3% vs 41.2% (P = .010), heparin/low-molecular weight heparin 5.3% vs 16.3% (P = .010), and coronary angiography 6.2% vs 16.8% (P = .027), respectively. The number of QI intervention hospitals reaching a treatment level of at least 70% in 4 or 5 of the 5 indicators was 15 and 5, respectively. In the control group, no hospital reached 70% or more in just 4 of the 5 indicators.
  
  
  CONCLUSIONS
  By combining a systematic and multidisciplinary QI collaborative with a web-based national quality registry with functionality allowing real-time performance feedback, major improvements in the adherence to national AMI guidelines can be achieved.
authors.affiliation: Uppsala Clinical Research Center, University Hospital, Uppsala, Sweden. rickard.carlhed@liv.se
authors.forename: Rickard
authors.initials: R
authors.lastname: Carlhed
authors.forename: Mats
authors.initials: M
authors.lastname: Bojestig
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Gunilla
authors.initials: G
authors.lastname: Lindström
authors.forename: Anette
authors.initials: A
authors.lastname: Peterson
authors.forename: Christina
authors.initials: C
authors.lastname: Aberg
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
mesh_terms: D000368:Aged; D003299:Cooperative Behavior; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D020407:Internet; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012042:Registries; D013548:Sweden