Impact of quality improvement activities on care for acute myocardial infarction

Objective. To examine the relationship between quality improvement activities reported to a peer review organization (PRO) and improvements in quality of care for patients with acute myocardial infarction (AMI). Design. Time-series, comparative study of changes in care for AMI patients from 1992 to 1995 in hospitals reporting self-measurement or system changes compared to all other hospitals in the state. Setting. One-hundred and seventeen acute care hospitals in Iowa. Study participants. Patients hospitalized with a principal diagnosis of AMI. Interventions. Each hospital was given hospital-specific performance data, statewide aggregate data, and peer comparisons and was asked to provide the PRO with a plan to improve care for AMI patients. Measurements. Chart audits were performed before and after the intervention. Quality of care was based on eight explicit process measures of the quality of AMI care (quality indicators). Results. Statewide, quality of care improved on five out of eight quality indicators. Of the 117 hospitals, 44 (38%) reported that they had implemented their own measurement activities or systematic improvements. These 44 hospitals showed significantly greater improvements than the other hospitals in use of aspirin during the hospitalization, recommendations for aspirin at discharge, and prescriptions for beta blockers at discharge. Conclusions. While quality of care for AMI patients throughout Iowa is improving, the pace of improvement is greatest in hospitals reporting that they are measuring their own performance or implementing systematic changes in care processes. Continued efforts to encourage hospitals to implement these types of improvement activities are warranted.