The “Toward Excellence in Care” Program: A Statewide Indicator Project

The “Toward Excellence in Care” program was launched by Connecticut hospitals and physicians in 1988 to develop and use quality-of-care indicators for use in quality improvement. Data came primarily from the Connecticut Health Information Management and Exchange (CHIME) database, which contains discharge abstract information, UB (uniform billing)-82 information, and additional data elements, for all of Connecticut’s 34 acute care hospitals. Linkages also occur with the state mortality database, the trauma registry, and with admission/discharge data within and across Connecticut hospitals. The “Toward Excellence in Care” program staff help the hospital use the data on indicator reports for quality improvement. On receiving a report on care for patients with acute myocardial infarction (AMI), a program representative summarized opportunities for improvement. The data were then disseminated to both the cardiology and the hospitalwide quality improvement staffs. Cardiologists conducted chart review on 100% of patients included in the last time-frame on the report (for example, fiscal year 1991). The quality improvement professional documented the system of care for an AMI patient Recommended actions included adoption of a policy for emergency department administration of thrombolytic therapy before a cardiology consultation, and modification of the postcoronary care program. Progress in addressing four challenges–easing the burden of data collection on the hospitals, maximizing acceptance of information by hospitals and physicians, risk adjusting data to permit comparison of outcomes, and facilitating understanding of reports–is reflected in expanding use of the “Toward Excellence in Care” program. The “Toward Excellence in Care” program provides not only indicator data reports to hospitals but also technical, administrative, and educational support to assist hospitals in assessing the data and identifying opportunities for improvement.