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 language | English |
|---|---|
| Pages (from-to) | 814-822 |
| Number of pages | 9 |
| Journal | Circulation |
| Volume | 113 |
| Issue number | 6 |
| DOIs | |
| State | Published - Feb 1 2006 |
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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 journal › Article
}
TY - JOUR
T1 - Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions
AU - Moscucci, Mauro
AU - Rogers, Eva Kline
AU - Montoye, Cecelia
AU - Smith, Dean E.
AU - Share, David
AU - O'Donnell, Michael
AU - Maxwell-Eward, Ann
AU - Meengs, William L.
AU - De Franco, Anthony C.
AU - Patel, Kirit
AU - McNamara, Richard
AU - McGinnity, John G.
AU - Jani, Sandeep M.
AU - Khanal, Sanjaya
AU - Eagl, Kim A.
PY - 2006/2/1
Y1 - 2006/2/1
N2 - 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.
AB - 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.
KW - Coronary disease
KW - Outcome
KW - Percutaneous coronary intervention
KW - Quality improvement
KW - Revascularization
UR - http://www.scopus.com/inward/record.url?scp=33644867584&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33644867584&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.105.541995
DO - 10.1161/CIRCULATIONAHA.105.541995
M3 - Article
C2 - 16461821
AN - SCOPUS:33644867584
VL - 113
SP - 814
EP - 822
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 6
ER -