Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions

Mauro Moscucci, Eva Kline Rogers, Cecelia Montoye, Dean E. Smith, David Share, Michael O'Donnell, Ann Maxwell-Eward, William L. Meengs, Anthony C. De Franco, Kirit Patel, Richard McNamara, John G. McGinnity, Sandeep M. Jani, Sanjaya Khanal, Kim A. Eagl

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Background - The objective of this study was to evaluate the association of a continuous quality improvement program with practice and outcome variations of percutaneous coronary intervention (PCI). Methods and Results - Data on consecutive PCI were collected in a consortium of 5 hospitals; 3731 PCIs reflected care provided at baseline (January 1, 1998, to December 31, 1998), and 5901 PCIs reflected care provided after implementation of a continuous quality improvement intervention (January 1, 2002, to December 31, 2002). The intervention included feedback on outcomes, working group meetings, site visits, selection of quality indicators, and use of bedside tools for quality improvement and risk assessment. Postintervention data were compared with baseline and with 10 287 PCIs from 7 hospitals added to the consortium in 2002. Quality indicators included use of preprocedural aspirin or clopidogrel, use of glycoprotein IIb/IIIa receptor blockers and postprocedural heparin, and amount of contrast media per case. Outcomes selected included emergency CABG, contrast nephropathy, myocardial infarction, stroke, transfusion, and in-hospital death. Compared with baseline and the control group, the intervention group at follow-up had higher use of preprocedural aspirin and glycoprotein IIb/IIIa blockers, lower use of postprocedural heparin, and a lower amount of contrast media per case (P<0.05). These changes were associated with lower rates of transfusions, vascular complications, contrast nephropathy, stroke, transient ischemic attack, and combined end points (all P<0.05). Conclusions - Our nonrandomized, observational data suggest that implementation of a regional continuous quality improvement program appears to be associated with enhanced adherence to quality indicators and improved outcomes of PCI. A randomized clinical trial is needed to determine whether this is a "causal" or a "casual" relationship.

Original languageEnglish
Pages (from-to)814-822
Number of pages9
JournalCirculation
Volume113
Issue number6
DOIs
StatePublished - Feb 1 2006

Fingerprint

Percutaneous Coronary Intervention
Quality Improvement
Platelet Glycoprotein GPIIb-IIIa Complex
clopidogrel
Contrast Media
Aspirin
Heparin
Stroke
Group Processes
Transient Ischemic Attack
Blood Vessels
Emergencies
Randomized Controlled Trials
Myocardial Infarction
Control Groups

Keywords

  • Coronary disease
  • Outcome
  • Percutaneous coronary intervention
  • Quality improvement
  • Revascularization

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions. / Moscucci, Mauro; Rogers, Eva Kline; Montoye, Cecelia; Smith, Dean E.; Share, David; O'Donnell, Michael; Maxwell-Eward, Ann; Meengs, William L.; De Franco, Anthony C.; Patel, Kirit; McNamara, Richard; McGinnity, John G.; Jani, Sandeep M.; Khanal, Sanjaya; Eagl, Kim A.

In: Circulation, Vol. 113, No. 6, 01.02.2006, p. 814-822.

Research output: Contribution to journalArticle

Moscucci, M, Rogers, EK, Montoye, C, Smith, DE, Share, D, O'Donnell, M, Maxwell-Eward, A, Meengs, WL, De Franco, AC, Patel, K, McNamara, R, McGinnity, JG, Jani, SM, Khanal, S & Eagl, KA 2006, 'Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions', Circulation, vol. 113, no. 6, pp. 814-822. https://doi.org/10.1161/CIRCULATIONAHA.105.541995
Moscucci, Mauro ; Rogers, Eva Kline ; Montoye, Cecelia ; Smith, Dean E. ; Share, David ; O'Donnell, Michael ; Maxwell-Eward, Ann ; Meengs, William L. ; De Franco, Anthony C. ; Patel, Kirit ; McNamara, Richard ; McGinnity, John G. ; Jani, Sandeep M. ; Khanal, Sanjaya ; Eagl, Kim A. / Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions. In: Circulation. 2006 ; Vol. 113, No. 6. pp. 814-822.
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