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Quality Improvement Initiative and Its Impact on the Management of Patients With Acute Myocardial Infarction
Rajendra H. Mehta, MD;
Sugata Das, MD;
Thomas T. Tsai, MD;
Elsie Nolan, MS, RN, CS;
Gwen Kearly, BSN, RN, CCRN;
Kim A. Eagle, MD
Arch Intern Med. 2000;160:3057-3062.
Background Wide variation exists in acute myocardial infarction (AMI) management, leading to differences in outcomes.
Objective To assess the impact of the quality improvement initiative on appropriate management of AMI.
Design Prospective patient identification, retrospective medical record review.
Patients All patients with AMI discharged alive (N = 497) from our institution between April 1, 1995, and February 28, 1997.
Main Outcome Measure The effect of quality improvements directed at the patient, nurse, and physician on the adherence to key quality indicators.
Results The quality improvement initiative correlated with more frequent use of reperfusion therapy (98%), and with aspirin use in the emergency department (95%), in ideal eligible patients. Similarly, adherence to discharge quality indicators, including use of aspirin (97%),  -blockers (94%), angiotensin-converting enzyme inhibitors (90%), and lipid-lowering agents (67%); avoidance of calcium channel blockers (93%); a low-fat diet (96%); smoking cessation counseling (94%); and outpatient rehabilitation referral (70%) was higher, including in the very old (those aged  80 years) and in women. The use of a patient education tool was associated with a higher adherence to most quality indicators compared with patients in whom this was not used: discharge aspirin (99% vs 96%; P = .02), -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; outpatient rehabilitation (82% vs 63%; P=.001); and documentation of smoking 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-directed feedback before discharge improved adherence to key indicators for AMI beyond that achieved with tools only directed at caregivers.
From the Heart Care Program and the Division of Cardiology, University of Michigan, Ann Arbor.
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