Objective. To examine the relationship between quality improvement activiti
es reported to a peer review organization (PRO) and improvements in quality
of care for patients with acute myocardial infarction (AMI).
Design. Time-series, comparative study of changes in care for AMI patients
from 1992 to 1995 in hospitals reporting self-measurement or system changes
compared to all other hospitals in the state.
Setting. One-hundred and seventeen acute care hospitals in Iowa.
Study participants. Patients hospitalized with a principal diagnosis of AMI
.
Interventions. Each hospital was given hospital-specific performance data,
statewide aggregate data, and peer comparisons and was asked to provide the
PRO with a plan to improve care for AMI patients.
Measurements. Chart audits were performed before and after the intervention
. Quality of care was based on eight explicit process measures of the quali
ty of AMI care (quality indicators).
Results. Statewide, quality of care improved on five out: of eight quality
indicators. Of the 117 hospitals, 44 (38%) reported that they had implement
ed their own measurement activities or systematic improvements. These 44 ho
spitals showed significantly greater improvements than the other hospitals
in use of aspirin during the hospitalization, recommendations for aspirin a
t discharge, and prescriptions for beta blockers at discharge.
Conclusions. While quality of care for AMI patients throughout Iowa is impr
oving, the pace of improvement is greatest in hospitals reporting that they
are measuring their own performance or implementing systematic changes in
care processes. Continued efforts to encourage hospitals to implement these
types of improve:ment activities are warranted.