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What's Happening in Quality Improvement at the Local Hospital: A State Wide Study From the Cooperative Cardiovascular ProjectRobert Wood Johnson Clinical Scholars Program, eholmboe{at}msn.com
Yale University School of Medicine in New Haven, Conn, and Qualidigm in Middletown, Conn
Qualidigm in Middletown, Conn, and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation in New Haven, Conn
Qualidigm in Middletown, Conn
Robert Wood Johnson Clinical Scholars Program, the Section of Chronic Disease Epidemiology, Department of Epidemiology, Yale University School of Medicine, Yale-New Haven Hospital Center for Outcomes Research and Evaluation in New Haven, Conn, and Qualidigm in Middletown, Conn The objective of this study was to investigate what happened to improve the quality of care for acute myocardial infarction (AMI) at all 32 nonfederal hospitals in Connecticut and to assess the impact of the Cooperative Cardiovascular Project (CCP) on quality improvement (QI) activities for AML We performed a questionnaire study with secondary analyses using the CCP database. On-site interviews were conducted with QI directors at all 32 Connecticut nonfederal hospitals that participated in the Health Care Financing Administration's Cooperative Cardiovascular Project (CCP) in 1992-93 and 1995. The interviews sought information about the makeup of QI departments, specific approaches used to improve the care of patients with AMI, and the perceived value of the CCP to each individual hospital. Results showed that the number of full-time equivalents (FTEs) and FTEs per beds employed in QI departments ranged from 1 to 30 and from 0.4 to 7.9, respectively, with a registered nurse most often serving as the department head (27/32). Over half of the departments (17/32) had additional responsibilities. The majority (25/32) used some combination of physician champions, multidisciplinary QI teams, standing orders, or critical pathways to effect change in AMI care. Finally, 26 of the 32 hospitals believed the CCP was valuable because it provided credible benchmark data, a catalyst for change, or a specific focus on processes of care needing improvement in AML Despite great variability in institutional resources, all 32 hospitals used a similar combination of QI approaches to effect change in AMI care. However, there is variable scientific evidence supporting these approaches. Externally sponsored projects such as the CCP appear to play a useful role for individual hospitals. Defining the optimal methods of QI is difficult given that hospitals are using complex combinations of nonstandardized improvement interventions.
Key Words: Acute myocardial infarction • peer review organization • quality improvement
American Journal of Medical Quality, Vol. 15, No. 3,
106-113 (2000) This article has been cited by other articles:
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