What's happening in quality improvement at the local hospital: A state-wide study from the cooperative cardiovascular project

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 Cardi o vascular Project (CCP) on quality improvement (QI) activities for AMI. We performed a questionnaire study with secondary analyses using the CCP data base. On site inter views were conducted with QI directors at all 32 Connec ticut nonfederal hospitals that participated in the Health Care Financing A dministration's Cooperative Cardiovascular Project (CCP) in 1992-93 and 199 5. The inter views sought information about the makeup of QI departments, s pecific approaches used to improve the care of patients with AMI, and the p erceived 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 ha lf 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 be cause it provided credible benchmark data, a catalyst for change, or a specific focu s on processes of care needing improvement in AMI. Despite great variabilit y in institutional resources, all 32 hospitals used a similar combination o f QI approaches to effect change in AMI care. However, there is variable sc ientific evidence supporting these approaches. Externally sponsored project s such as the CCP appear to play a useful role for individual hospitals. De fining the optimal methods of QI is difficult given that hospitals are usin g complex combinations of nonstandardized improvement interventions.