| Autor: |
Karen Reynolds, Kathy Viger, Hebe Quinton, Cathy Mingo, John D. Birkmeyer, Eric Anderson, David J. Malenka, Thomas J. Ryan, Cantwell Clark, William A. Burke, Jane Cleaves, Wanda Whittet, F. Stephen Larned, Richard L. White, Cathy Prouty, Diane Pappalardo, Desmond Donegal, James Schnitz, Paul T. Vaitkus, Nancy J. O'Connor, Gerald T. O'Connor, Patricia Peasley, Dee White, Lawrence J. Daeey, Candis Darcey, Elaine M. Olmstead, Joan F. Tryzelaar, Richard G. Brandenburg, Daniel S. Raabe, Richard S. Jackson, Cynthia M. Downs, Bruce Friedman, Saul Katz, Bruce Hettleman, Christopher T. Maloney, Kevin Berry, Frank Fedele, Alan D. Kaplan, Hebe B. Quinton, David E. Wennberg, Deborah Carey-Johnson, Jane Kane, Beth Wolf, John R. O'Meara, Dennis Redfield, Joanne Robichaud, Alyce Schultz, Michael J. Hearne, Edward R. Johnson, Linda Brewster, S. Cuddy, Bruce J. Leavitt, Edward Palank, Robert A. Clough, William C. Nugent, Stephen K. Plume, Alice Cirillo, Virginia Beggs, David Johnson, Jeremy R. Morton, Benjamin M. Westbrook, Richard A. Anderson, Christopher Terrien, Mirle A. Kellett, Susan Seekins, Pamela Brown, Edward R. Nowicki, Peggy Lambert, Thomas Dodds, Craig C. Berry, Shirley Shea, William F. Sullivan, Peter V. Lee, John Robb, Steve Colmanaro, Kirke W. Wheeler, David C. Charlesworth, Robert Kramer, Gordon Defoe, Linda Banister, Walter D. Gundel, William C. Paganelli, Jon Wahrenberger, Michael D. Brennan, Katrina Sargent, Nathaniel Niles, Charles A.S. Marrin, Chris A. Lutes, Carl E. Bredenberg, Helen McKinnon, David Burkey, Craig Warren, Dan Halstead, Seth Blank, Matthew Watkins, Ann Becker, Reed D. Quinn, Nancy Tooker, Joseph F. Kasper, Edward Catherwood, Elizabeth Maislen, Robert M. Hoffman, Erik J. Funk, Marie Turcotte, Patrick M. Lawrence, Joseph J. Hessel, William A. Bradley, M. Judith Porelle, Laurence H. Coffin, Wendy Perkins, Daniel F. Hanley, Claire Berg, Pat Fallo, Harold Osher, Russell Stogsdill, Donna Pulsifer, David C. Soule, Terry S. Kneeland, Warren D. Alpern, Mary Abbott, Paul W. Sweeny, Shelley Barber, Felix Hernandez, William Schults, Deborah Courtney, Karen Tolan, Cynthia Westlund, Mary Fillinger, Thomas P. Wharton, Kathy McNeil, Joshua Cutler, Jean Saunders, Robert C. Dewey, Robert B. Keller, Costas T. Lambrew, Yvon Baribeau, Carol Zografos, Louis I. Fink, Jeffery Lockhart, Ann Laramee, J. Beatty Hunter, Ted S. Silver, Craig Pedersen, Alan E. Garstka, Matthew L. Rowe, Lawrence Adrian |
| Rok vydání: |
1996 |
| Předmět: |
|
| Zdroj: |
JAMA: The Journal of the American Medical Association. 275:841 |
| ISSN: |
0098-7484 |
| Popis: |
Objective. —To determine whether an organized intervention including data feedback, training in continuous quality improvement techniques, and site visits to other medical centers could improve the hospital mortality rates associated with coronary artery bypass graft (CABG) surgery. Design. —Regional intervention study. Patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected on CABG patients in Northern New England between July 1, 1987, and July 31, 1993. Setting. —This study included all 23 cardiothoracic surgeons practicing in Maine, New Hampshire, and Vermont during the study period. Patients. —Data were collected on 15 095 consecutive patients undergoing isolated CABG procedures in Maine, New Hampshire, and Vermont during the study period. Interventions. —A three-component intervention aimed at reducing CABG mortality was fielded in 1990 and 1991. The interventions included feedback of outcome data, training in continuous quality improvement techniques, and site visits to other medical centers. Main Outcome Measure. —A comparison of the observed and expected hospital mortality rates during the postintervention period. Results. —During the postintervention period, we observed the outcomes for 6488 consecutive cases of CABG surgery. There were 74 fewer deaths than would have been expected. This 24% reduction in the hospital mortality rate was statistically significant ( P =.001). This reduction in mortality rate was relatively consistent across patient subgroups and was temporally associated with the interventions. Conclusion. —We conclude that a multi-institutional, regional model for the continuous improvement of surgical care is feasible and effective. This model may have applications in other settings. ( JAMA . 1996;275:841-846) |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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