Abstract
BackgroundQuality Improvement in Coronary Care, a Swedish multicenter, controlled quality-improvement (QI) collaborative, has shown significant improvements in adherence to national guidelines for acute myocardial infarction, as well as improved clinical outcome. The objectives of this report were to describe the sustainability of the improvements after withdrawal of study support and a consolidation period of 3 months and to report whether improvements were disseminated to treatments and diagnostic procedures other than those primarily targeted.Methods and ResultsMultidisciplinary teams from 19 Swedish hospitals were educated in basic QI methodologies. Another 19 matched hospitals were included as blinded controls. All evaluations were made on the hospital level, and data were obtained from a national quality registry, Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Sustainability indicators consisted of use of angiotensin-converting enzyme inhibitors, lipid-lowering therapy, clopidogrel, low-molecular weight heparin, and coronary angiography. Dissemination indicators were use of echocardiography, stress tests, and reperfusion therapy; time delays; and length of stay. At the reevaluation period of 6 months, the improvements at the QI intervention hospitals were sustained in all indicators but 1 (angiotensin-converting enzyme inhibitor). Between the 2 measurements, the control group improved significantly in all but 1 indicator (angiotensin-converting enzyme inhibitor). However, at the second measurement, the absolute adherence rates of the intervention hospitals were still numerically higher in all 5 indicators, and significantly so in 1 (clopidogrel). No significant changes were observed for the dissemination indicators.ConclusionsThe combination of a systematic QI collaborative with a national, interactive quality registry might lead to substantial and sustained improvements in the quality of acute myocardial infarction care. However, to achieve disseminated improvements in adjacent clinical measures, those adjacent measures probably should be made explicit before any QI intervention. (J Am Heart Assoc. 2012;1:e000737 doi: 10.1161/JAHA.112.000737.)
Highlights
There were no significant differences in baseline patient characteristics between the 2 hospital groups, except that the intervention hospitals had a slightly smaller proportion of patients with previous myocardial infarctions during both M1 and M2 and a lower prevalence of diabetes mellitus during M2 (Table 1)
We have shown that the Quality Improvement in Coronary Care (QUICC) intervention was successful in reaching its primary aims, with documented improvements in adherence to the national acute myocardial infarction (AMI) guidelines as well as improvements in clinical outcome.[4,7]
We addressed important questions formulated by some leading international researchers with experience from the collaborative model of QI: “If any improvements made are not maintained or spread after the collaborative, it is questionable whether a collaborative is worth the cost.”[12]. Undoubtedly, to justify a later expansion of a time- and resource-demanding QI effort such as the QUICC intervention, it has to be shown that the results are maintained
Summary
The objectives of this report were to describe the sustainability of the improvements after withdrawal of study support and a consolidation period of 3 months and to report whether improvements were disseminated to treatments and diagnostic procedures other than those primarily targeted
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