Rh. Mehta et al., Quality improvement initiative and its impact on the management of patients with acute myocardial infarction, ARCH IN MED, 160(20), 2000, pp. 3057-3062
Citations number
19
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: Wide variation exists in acute myocardial infarction (AMI) mana
gement, leading to differences in outcomes.
Objective: To assess the impact of the quality improvement initiative on ap
propriate management of AMI.
Design: Prospective patient identification, retrospective medical record re
view.
Patients: All patients with AMI discharged alive (N = 497) from our institu
tion between April 1, 1995, and February 28, 1997.
Main Outcome Measure: The effect of quality improvements directed at the pa
tient, nurse, and physician on the adherence to key quality indicators.
Results: The quality improvement initiative correlated with more frequent u
se of reperfusion therapy (98%), and with aspirin use in the emergency depa
rtment (95%), in ideal eligible patients. Similarly, adherence to discharge
quality indicators, including use of aspirin (97%), beta -blockers (94%),
angiotensin-converting enzyme inhibitors (90%), and lipid-lowering agents (
67%); avoidance of calcium channel blockers (93%); a low-fat diet (96%); sm
oking cessation counseling (94%); and outpatient rehabilitation referral (7
0%) was higher, including in the very old (those aged greater than or equal
to 80 years) and in women. The use of a patient education tool was associa
ted with a higher adherence to most quality indicators compared with patien
ts in whom this was not used: discharge aspirin (99% vs 96%; P = .02), beta
-blocker (98% vs 91%, P = .002), angiotensin-converting enzyme inhibitor (
95% vs 86%; P = .01), and lipid-lowering agent (71% vs 62%; P = .04) use; o
utpatient rehabilitation (82% vs 63%; P = .001); and documentation of smoki
ng cessation counseling (98% vs 87%; P = .001).
Conclusions: Implementation of a quality improvement program was associated
with a high adherence to quality-of-care indicators for AMI. Patient-direc
ted feedback before discharge improved adherence to key indicators for AMI
beyond that achieved with tools only directed at caregivers.