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Improving guideline adherence through intensive quality improvement and the use of a National Quality Register in Sweden for acute myocardial infarction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
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2007 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 16, no 1, 25-37 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Data from the Swedish National Register in Cardiac Care have shown over the last 10 years an enduring gap between optimal treatment of acute myocardial infarction (AMI) according to current guidelines and the treatment actually given. We performed a controlled, prospective study in order to evaluate the effects of applying a multidisciplinary team-based improvement methodology to the use of evidence-based treatments in AMI, together with the use of a modified National Quality Register. The project engaged 25% of the Swedish hospitals. METHOD: Multidisciplinary teams from 20 hospitals participating in the National Register in Cardiac Care, ranging from small to large hospitals, were trained in continuous quality improvement methodology. Twenty matched hospitals served as controls. Our efforts were focused on finding and applying tools and methods to increase adherence to the national guidelines for 5 different treatments for AMI. For measurement, specially designed quality control charts were made available in the National Register for Cardiac Care. RESULTS: To close the gap, an important issue for the teams was to get all 5 treatments in place. Ten of the hospitals in the study group reduced the gap in 5 of 5 treatments by 50%, while none of the control hospitals did so. CONCLUSIONS: This first, controlled prospective study of a registry supported by multidisciplinary team-based improvement methodology showed that this approach led to rapidly improved adherence to AMI guidelines in a broad spectrum of hospitals and that National Quality Registers can be helpful tools.

Place, publisher, year, edition, pages
2007. Vol. 16, no 1, 25-37 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-124560PubMedID: 17235249OAI: oai:DiVA.org:uu-124560DiVA: diva2:317675
Available from: 2010-05-04 Created: 2010-05-04 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Quality Improvement in Acute Coronary Care: Combining the Use of an Interactive Quality Registry with a Quality Improvement Collaborative to Improve Clinical Outcome in Patients with Acute Myocardial Infarction
Open this publication in new window or tab >>Quality Improvement in Acute Coronary Care: Combining the Use of an Interactive Quality Registry with a Quality Improvement Collaborative to Improve Clinical Outcome in Patients with Acute Myocardial Infarction
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists.

The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions.

19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy).

From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group.

The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted.

In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 813
Keyword
Quality Improvement, Quality Registry, Acute Coronary Care, Guideline Adherence
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-180327 (URN)978-91-554-8470-5 (ISBN)
Public defence
2012-10-26, Enghoff salen, Uppsala University Hospital, Entrance 50, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2012-10-04 Created: 2012-09-03 Last updated: 2013-01-23Bibliographically approved

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Lindahl, BertilLindström, GunillaÅberg, Christina

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