title: Targeted versus standard feedback: results from a randomized quality improvement trial.
abstract: BACKGROUND
  Quality improvement is central to improving the care of patients with cardiovascular disease; however, the optimum type of data feedback to support such efforts is unknown.
  
  
  METHODS
  Over 26 months, 149 eligible Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines hospitals were randomized to receive either standard (n = 76 control) or targeted (n = 73 intervention) performance feedback reports for acute myocardial infarction patient care. Each report summarized performance on identified metrics (providing hospitals with detailed data on their 3 lowest-performing quality metrics, relative to their peers). Intervention sites received 5 targeted feedback reports. Overall composite performance was compared between cohorts at end of study and as a change from baseline.
  
  
  RESULTS
  Intervention (n = 60) and control (n = 64) hospitals that completed the study had similar baseline performance (median score 83.7% vs 84.2%). Over 26 months of follow-up, the change in overall composite score across hospitals was neutral (median 0.1% [interquartile range {IQR} -2.4% to 3.3%]). There was no difference in observed improvement in either the intervention (median -0.2% [IQR-2.6% to 3.3%]) or control (median 0.1% [IQR -2.2% to 3.4%]) hospitals.
  
  
  CONCLUSIONS
  We were unable to demonstrate that targeted performance feedback reports lead to more rapid care improvements than standard reports. Future directions should explore the relationship between hospital self-selection of targeted metrics and the identification and promulgation of less common metrics--particularly those that reflect processes of care.
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: David M
authors.initials: DM
authors.lastname: Lofthus
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Poteat
authors.affiliation: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston MA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: Division of Cardiology, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: karen.alexander@duke.edu.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement; D012042:Registries