The broad objective of the proposed study is to increase our understanding of hospital-based interventions to improve care. The current research is aimed at expanding the paucity of information about methods to increase the utilization that can improve the quality of care, and, particularly, the use of beta- blockers, which have marked variation in usage across the country.
Our specific aims will be: to identify the hospital characteristics associated with the change in the use of beta-blockers over a three-year study period (1995-7) and to identify the hospital-based quality improvement interventions that are associated with a marked increase in the use of beta-blockers during the study period. The prescription of beta-blockers for patients after an acute myocardial infarction (AMI) represents an ideal opportunity to study methods of improving quality of care. During the last two decades, beta-blockers have been shown to reduce cardiovascular morbidity and mortality for survivors after AMI. The primary hypothesis of this study is that quality improvement strategies, not hospital characteristics themselves, are strongly associated with marked improvement in the use of beta-blockers at discharge, i.e., the hospitals that improve will not be a specific size or type. Instead, we hypothesize that marked improvement is most strongly associated with a comprehensive intervention strategy that includes the combination of explicit institutional endorsement of standards (e.g., critical pathways, standing orders), the monitoring and feedback of performance, and the clear designation of persons or teams with responsibility for change. To accomplish our aims, we propose a retrospective cohort study and nested case-control to identify hospital-based interventions that are associated with substantial improvements in the use of beta-blockers for survivors of an AMI. We will supplement data from the National Registry of Myocardial Infarction, a national registry of detailed patient information that has more than 600,000 hospitalizations in more than 1,500 hospitals, with information from interviews of QI managers and physicians at 300 hospitals with varying levels of performance. This latter part of the study will be enhanced through the additional partnership of Qualidigm (formerly the Connecticut Peer Review Organization) which will direct the collection of information from the hospitals, and which can provide, through Peer Review statutes, confidentiality for the data.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS010407-01
Application #
6076597
Study Section
Special Emphasis Panel (ZHS1-HCPR-C (03))
Program Officer
Keyes, Marge
Project Start
1999-09-30
Project End
2002-09-29
Budget Start
1999-09-30
Budget End
2000-09-29
Support Year
1
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
Nallamothu, Brahmajee K; Bates, Eric R; Wang, Yongfei et al. (2006) Driving times and distances to hospitals with percutaneous coronary intervention in the United States: implications for prehospital triage of patients with ST-elevation myocardial infarction. Circulation 113:1189-95
McNamara, Robert L; Herrin, Jeph; Bradley, Elizabeth H et al. (2006) Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002. J Am Coll Cardiol 47:45-51
Nallamothu, Brahmajee K; Wang, Yongfei; Magid, David J et al. (2006) Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction: National Registry of Myocardial Infarction-4 analysis. Circulation 113:222-9
Nallamothu, Brahmajee K; Bates, Eric R; Herrin, Jeph et al. (2005) Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation 111:761-7
Vaccarino, Viola; Rathore, Saif S; Wenger, Nanette K et al. (2005) Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med 353:671-82
Bradley, Elizabeth H; Herrin, Jeph; Wang, Yongfei et al. (2004) Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction. JAMA 292:1563-72
Bradley, E H; Holmboe, E S; Mattera, J A et al. (2004) Data feedback efforts in quality improvement: lessons learned from US hospitals. Qual Saf Health Care 13:26-31