Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative

William L. Holman, University of Alabama
Monique Sansom
Catarina I. Kiefe, University of Massachusetts Medical School
Eric D. Peterson, Duke University
Steve G. Hubbard
James F. Delong
Richard M. Allman, University of Alabama

Abstract

OBJECTIVE/BACKGROUND: This report describes the first round of results for Phase II of the Alabama CABG Project, a regional quality improvement initiative.

METHODS: Charts submitted by all hospitals in Alabama performing CABG (ICD-9 codes 36.10-36.20) were reviewed by a Clinical Data Abstraction Center (CDAC) (preintervention 1999-2000; postintervention 2000-2001). Variables that described quality in Phase I were abstracted for Phase II and data describing the new variables of beta-blocker use and lipid management were collected. Data samples collected onsite by participating hospitals were used for rapid cycle improvement in Phase II.

RESULTS: CDAC data (n = 1927 cases in 1999; n = 2001 cases in 2000) showed that improvements from Phase I in aspirin prescription, internal mammary artery use, and duration of intubation persisted in Phase II. During Phase II, use of beta-blockers before, during, or after CABG increased from 65% to 76% of patients (P < 0.05). Appropriate lipid management, an aggregate variable, occurred in 91% of patients before and 91% after the educational intervention. However, there were improvements in 3 of 5 subcategories for lipid management (documenting a lipid disorder [52%-57%], initiating drug therapy [45%-53%], and dietary counseling [74%-91%]; P < 0.05).

CONCLUSIONS: In Phase II, this statewide process-oriented quality improvement program added two new measures of quality. Achievements of quality improvement from Phase I persisted in Phase II, and improvements were seen in the new variables of lipid management and perioperative use of beta-blockers.