Improved adherence to Swedish national guidelines for acute myocardial infarction: The Quality Improvement in Coronary Care (QUICC) study - 18/08/11
, Mats Bojestig, MD, PhD b, Lars Wallentin, MD, PhD a, Gunilla Lindström, RN a, Anette Peterson, RN b, Christina Åberg, RN a, Bertil Lindahl, MD, PhD afor the QUICC study group
Riassunto |
Background |
The adherence to evidence-based treatment guidelines for acute myocardial infarction (AMI) is still suboptimal. Therefore, we designed a study to evaluate the effects of a collaborative quality improvement (QI) intervention on the adherence to AMI guidelines. The intervention used a national web-based quality registry to generate local and regular real-time performance feedback.
Methods |
A 12-month baseline measurement of the adherence rates was retrospectively collected, comprising the period July 1, 2001, through June 30, 2002. During the intervention period of November 1, 2002, through April 30, 2003, multidisciplinary teams from 19 nonrandomized intervention hospitals were subjected to a multifaceted QI-oriented intervention. Another 19 hospitals, unaware of their status as controls, were matched to the intervention hospitals. During the postintervention measurement period of May 1, 2003, through April 30, 2004, a total of 6726 consecutive patients were included at the intervention (n = 3786) and control (n = 2940) hospitals. The outcome measures comprised 5 Swedish national guideline-derived quality indicators, compared between baseline and postintervention levels in the control and QUICC intervention hospitals.
Results |
In the control and QI intervention hospitals, the mean absolute increase of patients receiving angiotensin-converting enzyme inhibitors was 1.4% vs 12.6% (P = .002), lipid-lowering therapy 2.3% vs 7.2% (P = .065), clopidogrel 26.3% vs 41.2% (P = .010), heparin/low–molecular weight heparin 5.3% vs 16.3% (P = .010), and coronary angiography 6.2% vs 16.8% (P = .027), respectively. The number of QI intervention hospitals reaching a treatment level of at least 70% in 4 or 5 of the 5 indicators was 15 and 5, respectively. In the control group, no hospital reached 70% or more in just 4 of the 5 indicators.
Conclusions |
By combining a systematic and multidisciplinary QI collaborative with a web-based national quality registry with functionality allowing real-time performance feedback, major improvements in the adherence to national AMI guidelines can be achieved.
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| This study was supported by the Federation of Swedish County Councils, Stockholm, Sweden. |
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| The funding agency had no direct role in the conduct of the study, the collection, management, statistical analyses, and interpretation of the data, preparation, or approval of the manuscript. |
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| Bertil Lindahl has received fees for speaking on satellite symposia and other educational meetings from Roche Diagnostica, Dade-Behring, Beckman-Coulter and Merck Sharp and Dohme. |
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| Proressor Lars Wallentin has been involved in clinical trials and received research grants from pharmaceutical companies, that is, Sanofi-Aventis, Astra-Zeneca, Boehringer-Ingelheim, Lilly, GSK, and Pfizer. |
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| Rickard Carlhed, Mats Bojestig, Christina Åberg, Gunilla Lindström, and Anette Peterson declare that no competing interests exist. |
Vol 152 - N° 6
P. 1175-1181 - Dicembre 2006 Ritorno al numero
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