Alabama Coronary Artery Bypass Grafting Project
| Autor: | Steadman S. Sankey, William L. Holman, Steve G. Hubbard, Monique Sansom, Kevin J. Anstrom, Richard M. Allman, Eric D. Peterson, Catarina I. Kiefe, Robert G. Sherrill |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Professional Review Organizations Statistics Nonparametric Coronary artery bypass surgery medicine Humans Intubation Hospital Mortality Derivation Coronary Artery Bypass Aged Aspirin business.industry Medical record General Medicine Odds ratio Middle Aged Survival Analysis United States Confidence interval Surgery Cardiac surgery Logistic Models Outcome and Process Assessment Health Care Emergency medicine Alabama Female business Surgery Department Hospital Total Quality Management medicine.drug |
| Zdroj: | JAMA. 285:3003 |
| ISSN: | 0098-7484 |
| DOI: | 10.1001/jama.285.23.3003 |
| Popis: | ContextEfforts to improve quality of care in the cardiac surgery field have focused on reducing the risk-adjusted mortality associated with common surgical procedures, such as coronary artery bypass grafting (CABG). However, the best methodological approach to improvement is under debate.ObjectiveTo test an intervention to improve performance of CABG surgery.Design and SettingQuality improvement project based on baseline (July 1, 1995–June 30, 1996) and follow-up (July 1–December 31, 1998) performance measurements from medical record review for all 20 Alabama hospitals that provided CABG surgery.PatientsMedicare patients discharged after CABG surgery in Alabama (n = 5784), a comparison state (n = 3214), and a national sample (n = 3758).InterventionConfidential hospital-specific performance feedback and assistance with multimodal improvement interventions, including the option to share relevant experience with peers.Main Outcome MeasuresDuration of intubation, reintubation rate, aspirin therapy at discharge, use of the internal mammary artery (IMA), hospital readmission rate, and risk-adjusted in-hospital mortality.ResultsProportion of extubation within 6 hours increased from 9% to 41% in Alabama, decreased from 40% to 39% in the comparison state, and increased from 12% to 25% in the national sample. Use of IMA increased from 73% to 84%, 48% to 55%, and 74% to 81%, respectively, in the 3 samples, but aspirin use increased only in Alabama (from 88% to 92%). The amount of improvement in all 3 of these process measures was greater in Alabama than in the other samples (IMA use for Alabama vs comparison state was P = .001 and for Alabama vs national sample, P = .02; and P |
| Databáze: | OpenAIRE |
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