A COLLABORATIVE PROJECT IN CONNECTICUT TO IMPROVE THE CARE OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Background: State-based peer review organizations (PROs) and individua l hospitals are challenged to achieve their quality improvement (QI) g oals with shrinking resources. In 1993-1994 tile Connecticut PRO and 1 5 local hospitals generated a comparative Qi database on acute myocard ial infarction (AMI) care for 1,202 Medicare and non-Medicare patients discharged in 1992 and 1993. Methods: A steering committee composed o f hospital and PRO representatives was assembled to provide oversight. PRO staff developed a chart abstraction tool and trained hospital abs tractors who collected and submitted data to the PRO for comparative a nalyses. Written feedback was provided to all hospitals and supplement ed with onsite presentations when requested. Each hospital prepared a written QI plan based on its unique data profile. Results: Opportuniti es for improvement were identified at all hospitals. The most commonly targeted areas for improvement included the use of thrombolytics at p resentation, aspirin at presentation and at discharge, and beta blocke rs at discharge. Improvement interventions included staff education se ssions, development of AMI critical paths and standing orders, and sto rage of appropriate medications in emergency departments. Sell-report data from the hospitals indicate improvements in care. Discussion: PRO s and hospitals can augment their individual QI activities by working together to share data, resources, and lessons learned. Twenty-three h ospitals are now collaborating with the Connecticut PRO on a similarly designed al project aimed at improving the care of patients hospitali zed with atrial fibrillation. This project includes a more formal mean s of communicating QI interventions.