title: Short- and long-term impact of an inpatient quality improvement initiative: results of the CABG-GAP Practice Improvement Project.
abstract: OBJECTIVE
  A significant percentage of patients undergoing coronary artery bypass graft (CABG) surgery leave the hospital without appropriate preventive medications. Little is known about this prevention gap and its solutions. We studied the short- and long-term impacts of a quality improvement (QI) project aimed at reducing this prevention gap.
  
  
  METHODS
  A sequential 3-phase QI project was performed in patients undergoing CABG surgery in Olmsted County, MN, from April 2001 to March 2002. In phase 1 (n = 213), cardiovascular surgery team members were given a pocket reminder card with preventive medication guidelines. In phase 2 (n = 182), monthly team feedback reports were added. In phase 3 (n = 199), a "refrigerator magnet" patient reminder card listing prescribed medications was added. A baseline comparison group (n = 305) was selected randomly from patients undergoing CABG surgery in 2000. Patient receipt of preventive medications and all-cause mortality were compared.
  
  
  RESULTS
  Prescription of lipid-lowering medications (LLM) increased with each incremental QI tool as compared with baseline (P < .001). Nonsignificant trends were noted for aspirin, angiotensin-converting enzyme inhibitors, and β-blockers. At 1 year, the use of LLM was similarly high in all groups and was associated with cardiac rehabilitation use. Short- and long-term mortality rates did not differ between study groups.
  
  
  CONCLUSIONS
  Our inpatient QI tools resulted in early, high LLM use, but the treatment advantage of the interventions was erased by 1 year and no survival benefit was noted. Our study illustrates the importance of tracking long-term outcomes in QI projects and suggests that outpatient cardiac rehabilitation is associated with long-term use of LLM.
authors.affiliation: Cardiovascular Health Clinic, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA. Thomas.randal@mayo.edu
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
authors.forename: Kashish
authors.initials: K
authors.lastname: Goel
authors.forename: Marwan
authors.initials: M
authors.lastname: Jumean
authors.forename: Charles
authors.initials: C
authors.lastname: Mullany
authors.forename: Brian
authors.initials: B
authors.lastname: Lahr
authors.forename: Ray
authors.initials: R
authors.lastname: Gibbons
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000592:standards*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007297:Inpatients; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors