Influencing care in acute myocardial infarction: A randomized trial comparing 2 types of intervention

The purpose of this study was to evaluate performance feedback delivered by on-site presentations compared to mailed feedback on improving acute myoca rdial infarction (AMI) care. We used a randomized trial including 18 hospit als nested within the Cooperative Cardiovascular Project. Patients comprise d AMI Medicare patients admitted before (n = 929, 1994 and 1995) and after intervention (n = 438, 1996), Control hospitals received written feedback b y mail. The experimental intervention group received a presentation led by a cardiologist and a quality improvement specialist, Pie assessed the propo rtion of patients receiving appropriate AMI care before and after the inter vention. Both univariate and multivariate analyses demonstrated no effect o f the intervention in increasing the proportion of patients who received re perfusion, aspirin, beta-blockers, or angiotensin-converting enzyme inhibit ors, On-site feedback presentations were not associated with a larger impro vement in AMI care compared to the mailed feedback. Other interventions, su ch as opinion leaders and patient-directed interventions, may be necessary in order to improve the care of AMI patients.