Randomized trial of targeted performance feedback to facilitate quality improvement in acute myocardial infarction care.
BACKGROUND
Efforts to improve quality of care for patients with acute myocardial infarction (AMI) are a national priority. To date, there have been few studies that have prospectively evaluated hospital quality improvement (QI) interventions.


RESULTS
Using hospitals in the National Cardiovascular Data Registry (NCDR) ACTION Registry-GWTG, a cluster randomized trial of the effectiveness of targeted performance feedback to facilitate process improvement for AMI care will be conducted. ACTION Registry-GWTG hospitals with a minimum of 50 AMI patients per 2 quarters are eligible for randomization. The control arm receives standard performance feedback reports, and the intervention arm receives standard performance feedback reports in addition to a supplemental report on the "top 3" centrally identified, hospital-specific performance gaps. The primary outcome will be improvement in a composite of all metrics, and the secondary outcome will be improvement in the targeted metrics. At study inception in January 2009, 149 sites were randomized: 76 to the intervention arm, and 73 to the control arm. Intervention and control sites were well balanced in terms of baseline performance, center characteristics, and AMI volume (≈70 patients per quarter). The intervention phase will continue for 5 feedback cycles, each containing 2 quarters of data feedback over 18 months. A final trial outcome report will follow.


CONCLUSIONS
This randomized trial will evaluate a novel hospital-level QI intervention of targeted performance feedback for AMI, thereby demonstrating the effective use of national registries for QI and furthering our understanding of effective QI methods.
Duke Clinical Research Institute, Durham, NC 27710, USA. karen.alexander@duke.edu
Karen P
KP
Alexander
Tracy Y
TY
Wang
Shuang
S
Li
Barbara L
BL
Lytle
Lara E
LE
Slattery
Sarah
S
Calhoun
Jennifer
J
Poteat
Matthew T
MT
Roe
John S
JS
Rumsfeld
Christopher P
CP
Cannon
Eric D
ED
Peterson
D000208:Acute Disease; D005246:Feedback; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care
Arch Intern Med. 2009 Aug 10;169(15):1411-9
19667305
Arch Intern Med. 2006 Oct 9;166(18):2027-34
17030838
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):491-9
20031882
Circulation. 2008 Dec 9;118(24):2596-648
19001027
N Engl J Med. 2007 Aug 9;357(6):608-13
17687138
J Am Coll Cardiol. 2005 Oct 18;46(8):1479-87
16226171
JAMA. 2005 Jul 20;294(3):309-17
16030275
J Am Coll Cardiol. 2004 Jun 16;43(12):2166-73
15193675
JAMA. 1998 May 6;279(17):1358-63
9582043
Circulation. 2009 Dec 1;120(22):2271-306
19923169
J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157
17692738
N Engl J Med. 2007 Sep 20;357(12):1175-7
17881749
Acad Emerg Med. 2002 Nov;9(11):1146-55
12414463
J Am Coll Cardiol. 2008 Dec 9;52(24):2113-7
19056002
JAMA. 1998 May 6;279(17):1351-7
9582042
J Am Coll Cardiol. 2009 Dec 15;54(25):2423-9
20082933
JAMA. 2008 May 21;299(19):2319-21
18492974
JAMA. 2003 Jul 2;290(1):49-56
12837711
JAMA. 2006 Apr 26;295(16):1912-20
16639050
Am J Med Qual. 2000 Sep-Oct;15(5):197-206
11022366
JAMA. 2001 Jun 13;285(22):2871-9
11401608
Med Care. 2005 Mar;43(3):282-92
15725985
Qual Saf Health Care. 2004 Feb;13(1):26-31
14757796