title: Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice.
abstract: BACKGROUND
  Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting.
  
  
  RESULTS
  A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications at intervention versus control sites, assessed by measuring preintervention and postintervention site differences. Prerandomization treatment patterns and baseline data were similar in the control (n=234) and treatment (n=224) groups. Individual medication use and composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 secondary prevention medications.
  
  
  CONCLUSIONS
  Provider-led, low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Delong
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Dokholyan
authors.forename: Fang-Shu
authors.initials: FS
authors.lastname: Ou
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000639:trends; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000639:trends; D012042:Registries; D055502:Secondary Prevention / Q000379:methods* / Q000639:trends; D012955:Societies, Medical / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D001241:Aspirin