A REGIONAL INTERVENTION TO IMPROVE THE HOSPITAL MORTALITY ASSOCIATED WITH CORONARY-ARTERY BYPASS GRAFT-SURGERY

Objective.-To determine whether an organized intervention including da ta feedback, training in continuous quality improvement techniques, an d site visits to other medical centers could improve the hospital mort ality rates associated with coronary artery bypass graft (CABG) surger y. Design.-Regional intervention study. Patient demographic and histor ical data, body surface area, cardiac catheterization results, priorit y of surgery, comorbidity, and status at hospital discharge were colle cted on CABG patients in Northern New England between July 1, 1987, an d July 31, 1993. Setting.-This study included all 23 cardiothoracic su rgeons practicing in Maine, New Hampshire, and Vermont during the stud y period. Patients.-Data were collected on 15 095 consecutive patients undergoing isolated CABG procedures in Maine, New Hampshire, and Verm ont during the study period. Interventions.-A three-component interven tion aimed at reducing CABG mortality was fielded in 1990 and 1991. Th e interventions included feedback of outcome data, training in continu ous quality improvement techniques, and site visits to other medical c enters. Main Outcome Measure.-A comparison of the observed and expecte d hospital mortality rates during the postintervention period. Results .-During the postintervention period, we observed the outcomes for 648 8 consecutive cases of CABG surgery, There were 74 fewer deaths than w ould have been expected. This 24% reduction in the hospital mortality rate was statistically significant (P=.001). This reduction in mortali ty rate was relatively consistent across patient subgroups and was tem porally associated with the interventions. Conclusion.-We conclude tha t a multi-institutional, regional model for the continuous improvement of surgical care is feasible and effective. This model may have appli cations in other settings.