title: A statewide quality collaborative for process improvement: internal mammary artery utilization.
abstract: BACKGROUND
  The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative is a voluntary, surgeon-directed quality initiative involving all cardiac surgery programs in Michigan. Understanding that internal mammary artery (IMA) use during coronary artery bypass grafting is an important process measure associated with improved outcomes, this analysis reviews our methodology to understand IMA use and increase appropriate IMA use statewide.
  
  
  METHODS
  Adult cardiac Society of Thoracic Surgeons data were collected at each Michigan site and submitted quarterly to the Duke Clinical Research Institute and the MSTCVS. Seven cardiac surgery programs with IMA use less than 90% in isolated coronary artery bypass grafting were identified as low IMA users. An improvement plan was adopted at the state level and included quarterly monitoring of IMA use, documenting the rationale for IMA exclusion, evidence-based lectures, feedback letters to sites, and physician-led site visits if no improvement was noted.
  
  
  RESULTS
  From 2005 through 2008, 29,114 patients underwent coronary artery bypass grafting in Michigan. Internal mammary artery utilization varied widely at the beginning of this investigation, ranging from 66.2% to 98.4%. Seven Michigan programs were identified as low IMA users. Using the MSTCVS Quality Collaborative's process-improvement plan, collectively the seven low IMA users increased IMA grafting from 82.0% to 92.7% (p < 0.0001). Michigan IMA use increased from 91.9% to 95.8% (p < 0.0001) and is now higher than The Society of Thoracic Surgeons' average.
  
  
  CONCLUSIONS
  The MSTCVS Quality Collaborative identified programs with low IMA use and created an environment to enhance IMA utilization during coronary artery bypass grafting, a significant operative process. These findings illustrate the value of a statewide surgeon-directed quality initiative in improving processes and outcomes for patients.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Sparrow Hospital, Lansing, Michigan, USA.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Johnson
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Theurer
authors.forename: Gail F
authors.initials: GF
authors.lastname: Bell
authors.forename: Luigi
authors.initials: L
authors.lastname: Maresca
authors.forename: Thomas
authors.initials: T
authors.lastname: Leyden
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000706:statistics & numerical data*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008824:Michigan; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D016896:Treatment Outcome