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JAMA. 2001 May 23-30;285(20):2604-11.

A qualitative study of increasing beta-blocker use after myocardial infarction: Why do some hospitals succeed?

Author information

1
Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA.

Abstract

CONTEXT:

Based on evidence that beta-blockers can reduce mortality in patients with acute myocardial infarction (AMI), many hospitals have initiated performance improvement efforts to increase prescription of beta-blockers at discharge. Determination of the factors associated with such improvements may provide guidance to hospitals that have been less successful in increasing beta-blocker use.

OBJECTIVES:

To identify factors that may influence the success of improvement efforts to increase beta-blocker use after AMI and to develop a taxonomy for classifying such efforts.

DESIGN, SETTING, AND PARTICIPANTS:

Qualitative study in which data were gathered from in-depth interviews conducted in March-June 2000 with 45 key physician, nursing, quality management, and administrative participants at 8 US hospitals chosen to represent a range of hospital sizes, geographic regions, and changes in beta-blocker use rates between October 1996 and September 1999.

MAIN OUTCOME MEASURES:

Initiatives, strategies, and approaches to improve care for patients with AMI.

RESULTS:

The interviews revealed 6 broad factors that characterized hospital-based improvement efforts: goals of the efforts, administrative support, support among clinicians, design and implementation of improvement initiatives, use of data, and modifying variables. Hospitals with greater improvements in beta-blocker use over time demonstrated 4 characteristics not found in hospitals with less or no improvement: shared goals for improvement, substantial administrative support, strong physician leadership advocating beta-blocker use, and use of credible data feedback.

CONCLUSIONS:

This study provides a context for understanding efforts to improve care in the hospital setting by describing a taxonomy for classifying and evaluating such efforts. In addition, the study suggests possible elements of successful efforts to increase beta-blocker use for patients with AMI.

PMID:
11368734
DOI:
10.1001/jama.285.20.2604
[Indexed for MEDLINE]

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