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Article
Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative
Quantitative Health Sciences Publications and Presentations
  • 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
UMMS Affiliation
Department of Quantitative Health Sciences
Date
12-20-2003
Document Type
Article
Medical Subject Headings
Adrenergic beta-Antagonists; Aged; Alabama; Aspirin; Benchmarking; Cardiology Service, Hospital; Coronary Artery Bypass; Coronary Artery Disease; Female; Graft Rejection; Graft Survival; Health Services Research; Hospital Mortality; Humans; Male; Middle Aged; Outcome and Process Assessment (Health Care); Postoperative Care; Program Evaluation; *Quality Assurance, Health Care; Severity of Illness Index; Surgery Department, Hospital; Survival Analysis; Total Quality Management
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.
Rights and Permissions
Citation: Ann Surg. 2004 Jan;239(1):99-109. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Citation Information
William L. Holman, Monique Sansom, Catarina I. Kiefe, Eric D. Peterson, et al.. "Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative" Vol. 239 Iss. 1 (2003) ISSN: 0003-4932 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/130/