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Med J Aust. 2004 Apr 19;180(8):392-7.

Multisite, quality-improvement collaboration to optimise cardiac care in Queensland public hospitals.

Author information

  • 1Internal Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, QLD 4102, Australia. ian_scott@health.qld.gov.au

Abstract

OBJECTIVE:

To evaluate changes in quality of in-hospital care of patients with either acute coronary syndromes (ACS) or congestive heart failure (CHF) admitted to hospitals participating in a multisite quality improvement collaboration.

DESIGN:

Before-and-after study of changes in quality indicators measured on representative patient samples between June 2001 and January 2003.

SETTING:

Nine public hospitals in Queensland.

STUDY POPULATIONS:

Consecutive or randomly selected patients admitted to study hospitals during the baseline period (June 2001 to January 2002; n = 807 for ACS, n = 357 for CHF) and post-intervention period (July 2002 to January 2003; n = 717 for ACS, n = 220 for CHF).

INTERVENTION:

Provision of comparative baseline feedback at a facilitative workshop combined with hospital-specific quality-improvement interventions supported by on-site quality officers and a central program management group.

MAIN OUTCOME MEASURE:

Changes in process-of-care indicators between baseline and post-intervention periods.

RESULTS:

Compared with baseline, more patients with ACS in the post-intervention period received therapeutic heparin regimens (84% v 72%; P < 0.001), angiotensin-converting enzyme inhibitors (64% v 56%; P = 0.02), lipid-lowering agents (72% v 62%; P < 0.001), early use of coronary angiography (52% v 39%; P < 0.001), in-hospital cardiac counselling (65% v 43%; P < 0.001), and referral to cardiac rehabilitation (15% v 5%; P < 0.001). The numbers of patients with CHF receiving beta-blockers also increased (52% v 34%; P < 0.001), with fewer patients receiving deleterious agents (13% v 23%; P = 0.04). Same-cause 30-day readmission rate decreased from 7.2% to 2.4% (P = 0.02) in patients with CHF.

CONCLUSION:

Quality-improvement interventions conducted as multisite collaborations may improve in-hospital care of acute cardiac conditions within relatively short time frames.

PMID:
15089729
[PubMed - indexed for MEDLINE]
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