TY - JOUR
T1 - Short-and long-term impact of an inpatient quality improvement initiative
T2 - Results of the cabg-gap practice improvement project
AU - Thomas, Randal J.
AU - Goel, Kashish
AU - Jumean, Marwan
AU - Mullany, Charles
AU - Lahr, Brian
AU - Gibbons, Ray
PY - 2013/7
Y1 - 2013/7
N2 - PURPOSE: A significant percentage of patients undergoing coronary artery bypass graft (CABG) surgery leave the hospital without appropriate preventive medications. Little is known about this prevention gap and its solutions. We studied the short-and long-term impacts of a quality improvement (QI) project aimed at reducing this prevention gap. METHODS: A sequential 3-phase QI project was performed in patients undergoing CABG surgery in Olmsted County, MN, from April 2001 to March 2002. In phase 1 (n = 213), cardiovascular surgery team members were given a pocket reminder card with preventive medication guidelines. In phase 2 (n = 182), monthly team feedback reports were added. In phase 3 (n = 199), a "refrigerator magnet" patient reminder card listing prescribed medications was added. A baseline comparison group (n = 305) was selected randomly from patients undergoing CABG surgery in 2000. Patient receipt of preventive medications and all-cause mortality were compared. RESULTS: Prescription of lipid-lowering medications (LLM) increased with each incremental QI tool as compared with baseline (P <.001). Nonsignificant trends were noted for aspirin, angiotensin-converting enzyme inhibitors, and β-blockers. At 1 year, the use of LLM was similarly high in all groups and was associated with cardiac rehabilitation use. Short-and long-term mortality rates did not differ between study groups. CONCLUSIONS: Our inpatient QI tools resulted in early, high LLM use, but the treatment advantage of the interventions was erased by 1 year and no survival benefit was noted. Our study illustrates the importance of tracking long-term outcomes in QI projects and suggests that outpatient cardiac rehabilitation is associated with long-term use of LLM.
AB - PURPOSE: A significant percentage of patients undergoing coronary artery bypass graft (CABG) surgery leave the hospital without appropriate preventive medications. Little is known about this prevention gap and its solutions. We studied the short-and long-term impacts of a quality improvement (QI) project aimed at reducing this prevention gap. METHODS: A sequential 3-phase QI project was performed in patients undergoing CABG surgery in Olmsted County, MN, from April 2001 to March 2002. In phase 1 (n = 213), cardiovascular surgery team members were given a pocket reminder card with preventive medication guidelines. In phase 2 (n = 182), monthly team feedback reports were added. In phase 3 (n = 199), a "refrigerator magnet" patient reminder card listing prescribed medications was added. A baseline comparison group (n = 305) was selected randomly from patients undergoing CABG surgery in 2000. Patient receipt of preventive medications and all-cause mortality were compared. RESULTS: Prescription of lipid-lowering medications (LLM) increased with each incremental QI tool as compared with baseline (P <.001). Nonsignificant trends were noted for aspirin, angiotensin-converting enzyme inhibitors, and β-blockers. At 1 year, the use of LLM was similarly high in all groups and was associated with cardiac rehabilitation use. Short-and long-term mortality rates did not differ between study groups. CONCLUSIONS: Our inpatient QI tools resulted in early, high LLM use, but the treatment advantage of the interventions was erased by 1 year and no survival benefit was noted. Our study illustrates the importance of tracking long-term outcomes in QI projects and suggests that outpatient cardiac rehabilitation is associated with long-term use of LLM.
KW - CABG surgery
KW - quality improvement
KW - secondary prevention
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U2 - 10.1097/HCR.0b013e3182930cd0
DO - 10.1097/HCR.0b013e3182930cd0
M3 - Article
C2 - 23719148
AN - SCOPUS:84880326069
SN - 1932-7501
VL - 33
SP - 212
EP - 219
JO - Journal of Cardiopulmonary Rehabilitation and Prevention
JF - Journal of Cardiopulmonary Rehabilitation and Prevention
IS - 4
ER -