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Circ Cardiovasc Qual Outcomes. 2018 Nov;11(11):e004756. doi: 10.1161/CIRCOUTCOMES.118.004756.

Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery.

Author information

1
Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.S.L., L.C., R.L.P.).
2
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., L.C., R.J.S., R.L.P.).
3
Heart and Vascular Institute, Henry Ford Macomb Hospitals, Clinton Township, MI (S.D.H.).
4
Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, MI (A.D.).
5
Department of Internal Medicine, University of Michigan, Ann Arbor (C.E.C.).
6
VA Ann Arbor Healthcare System and Department of Internal Medicine, University of Michigan, Ann Arbor (S.L.K.).
7
Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University, Durham, NC (D.T., R.A.M.).
8
Department of Biostatistics, University of Michigan, Ann Arbor (M.Z.).
9
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.).

Abstract

BACKGROUND:

To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program.

METHODS AND RESULTS:

We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative). Unlike STS hospitals not participating in the MI-Collaborative (i.e., STSnonMI) that solely received blinded reports, MI-Collaborative hospitals received a multi-faceted intervention starting November 2012 (quarterly in-person meetings showcasing unblinded data, webinars, site visits). Eighteen of the MI-Collaborative hospitals received additional support to implement recommended pneumonia prevention practices ("MI-CollaborativePlus"), whereas 15 did not ("MI-CollaborativeOnly"). We evaluated rates of postoperative pneumonia, adjusting for patient mix and hospital effects. Baseline patient characteristics were qualitatively similar between groups and time. During the pre-intervention period, there was a 2.53% per quarter reduction in the adjusted neumonia odds ratio for STS hospitals not participating in the MI-Collaborative ( P<0.001), which was equivalent to the MI-Collaborative ( P>0.05). During the intervention period, there was a significant 2% reduction in the adjusted odds ratio for pneumonia for MI-Collaborative hospitals relative to the STS hospitals not participating in the MI-Collaborative, although was 3% significantly lower among the MI-CollaborativeOnly hospitals. The STS hospitals not participating in the MI-Collaborative had a 1.96% reduction in risk-adjusted pneumonia, which was less than the MI-Collaborative (3.23%, P=0.011). The MI-CollaborativePlus reduced adjusted pneumonia rates by 10.29%, P=0.001.

CONCLUSIONS:

Participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. Interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov . Unique identifier: NCT02068716.

KEYWORDS:

Cardiopulmonary bypass; infection; thoracic surgery

PMID:
30571334
PMCID:
PMC6310019
[Available on 2019-11-01]
DOI:
10.1161/CIRCOUTCOMES.118.004756

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