title: Use of quality improvement interventions and the link to performance on percutaneous intervention for acute myocardial infarction.
abstract: BACKGROUND
  Despite numerous calls for hospitals to employ quality improvement (QI) interventions to improve emergency department (ED) performance, their impact has not been explored in multi-site investigations.
  
  
  OBJECTIVE
  We investigated the association between use of QI interventions (patient flow strategies, ED electronic dashboards, and five-level triage systems) and hospital performance on receipt of percutaneous intervention (PCI) within 90 min for acute myocardial infarction patients, a publicly available quality measure.
  
  
  METHODS
  This was an exploratory, cross-sectional analysis of secondary data from 292 hospitals. Data were drawn from the Quality Improvement Activities Survey, the American Hospital Association's Annual Survey, and Hospital Compare. Linear regression models were used to detect differences in PCI performance scores based on whether hospitals employed one or more QI interventions.
  
  
  RESULTS
  Fifty-three percent of hospitals reported widespread use of patient flow strategies, 62% reported using a dashboard, and 74% reported using a five-level triage system. Time to PCI performance scores were 3.5 percentage points higher (i.e., better) for hospitals that used patient flow strategies and 6.2 percentage points higher for hospitals that used a five-level triage system. Scores were 10.4 percentage points higher at hospitals that employed two quality improvement interventions and 12.8 percentage points higher at hospitals that employed three.
  
  
  CONCLUSIONS
  Employing QI interventions was associated with better PCI scores. More research is needed to explore the direction of this relationship, but results suggest that hospitals should consider adopting patient flow strategies, electronic dashboards, and five-level triage systems to improve PCI scores.
authors.affiliation: Center for Healthcare Studies, Chicago, Illinois; Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Megan
authors.initials: M
authors.lastname: McHugh
authors.affiliation: Center for Healthcare Studies, Chicago, Illinois.
authors.forename: Raymond
authors.initials: R
authors.lastname: Kang
authors.affiliation: School of Management, Boston University, Boston, Massachusetts.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Cohen
authors.affiliation: School of Management, Boston University, Boston, Massachusetts.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Restuccia
authors.affiliation: Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Harvard Medical School, Boston, Massachusetts.
authors.forename: Usha
authors.initials: U
authors.lastname: Periyanayagam
authors.affiliation: Center for Healthcare Studies, Chicago, Illinois; Patient-Centered Outcomes Research Institute (Current Appointment), Washington, DC.
authors.forename: Romana
authors.initials: R
authors.lastname: Hasnain-Wynia
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000592:standards* / Q000706:statistics & numerical data; D015397:Program Evaluation; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods
keywords: PCI; health policy; performance measurement; quality improvement