title: Improving guideline adherence through intensive quality improvement and the use of a National Quality Register in Sweden for acute myocardial infarction.
abstract: OBJECTIVE
  Data from the Swedish National Register in Cardiac Care have shown over the last 10 years an enduring gap between optimal treatment of acute myocardial infarction (AMI) according to current guidelines and the treatment actually given. We performed a controlled, prospective study in order to evaluate the effects of applying a multidisciplinary team-based improvement methodology to the use of evidence-based treatments in AMI, together with the use of a modified National Quality Register. The project engaged 25% of the Swedish hospitals.
  
  
  METHODS
  Multidisciplinary teams from 20 hospitals participating in the National Register in Cardiac Care, ranging from small to large hospitals, were trained in continuous quality improvement methodology. Twenty matched hospitals served as controls. Our efforts were focused on finding and applying tools and methods to increase adherence to the national guidelines for 5 different treatments for AMI. For measurement, specially designed quality control charts were made available in the National Register for Cardiac Care.
  
  
  RESULTS
  To close the gap, an important issue for the teams was to get all 5 treatments in place. Ten of the hospitals in the study group reduced the gap in 5 of 5 treatments by 50%, while none of the control hospitals did so.
  
  
  CONCLUSIONS
  This first, controlled prospective study of a registry supported by multidisciplinary team-based improvement methodology showed that this approach led to rapidly improved adherence to AMI guidelines in a broad spectrum of hospitals and that National Quality Registers can be helpful tools.
authors.affiliation: County Council of Jönköping, Sweden. anette.peterson@lj.se
authors.forename: Anette
authors.initials: A
authors.lastname: Peterson
authors.forename: Rickard
authors.initials: R
authors.lastname: Carlhed
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Gunilla
authors.initials: G
authors.lastname: Lindström
authors.forename: Christina
authors.initials: C
authors.lastname: Aberg
authors.forename: Boel
authors.initials: B
authors.lastname: Andersson-Gäre
authors.forename: Mats
authors.initials: M
authors.lastname: Bojestig
mesh_terms: D000208:Acute Disease; D019983:Guideline Adherence; D007362:Intensive Care Units; D009203:Myocardial Infarction / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration; D012042:Registries; D013222:State Medicine / Q000458:organization & administration*; D013548:Sweden