A Regional Intervention to Improve the Hospital Mortality Associated With Coronary Artery Bypass Graft Surgery

O’Connor, Gerald T.; Plume, Stephen K.; Olmstead, Elaine M.; Morton, Jeremy R.; Maloney, Christopher T.; Nugent, William C.; Hernandez, Felix; Clough, Robert A.; Leavitt, Bruce J.; Coffin, Laurence H.; Marrin, Charles A.S.; Wennberg, David E.; Birkmeyer, John D.; Charlesworth, D.; Malenka, David J.; Kasper, Joseph F.; Quinton, Hebe B.; Carey-Johnson, Deborah; Downs, Cynthia; Hessel, Joseph J.; Hoffman, Robert M.; Johnson, Edward R.; McKinnon, Helen; Mingo, Cathy; Pedersen, Craig A.; Perkins, Wendy; Rowe, Matthew L.; Sargent, Katrina; Silver, Ted; Lee, Peter Ver; Warren, Craig S; Barber, Shelley; Brown, Pamela M R; Brandenburg, R. G.; Colmanaro, Steve; Gundel, Walter D.; Jackson, Richard S.; Johnson, David B.; Laramee, Ann S.; Paganelli, William C.; Pappalardo, D.; Raabe, Daniel S.; Terrien, Christopher M.; Vaitkus, Paul T.; Watkins, Matthew W.; Beggs, V.; Burke, William M.; Catherwood, Edward; Daeey, Lawrence J.; Darcey, Candis; DeFoe, Gordon R.; Dodds, T. Andrew; Fillinger, Mary P.; Friedman, Bruce; Hettleman, Bruce; Kneeland, Terry; Maislen, Elizabeth; Niles, Nathaniel W.; O’Connor, Nancy J.; Robb, John F.; Schults, William C.; Sullivan, William F.; Wahrenberger, Jon; Wolf, Beth O; Baribeau, Yvon R.; Becker, Ann De; Berry, Craig C.; Berry, Kevin; Bradley, William A.; Cuddy, Sarah; Dewey, Robert C.; Fedele, F.; Fink, Louis I.; Funk, Erik J.; Garstka, Alan E.; Halstead, Dan; Hearne, Michael J.; Hunter, Jay B.; Kaplan, Alan D.; Lambert, P.; Lawrence, Patrick M.; Lockhart, Jeffery; McNeil, Kathy; Palank, Edward A.; Porelle, M. Judith; Pulsifer, Donna; Robichaud, Joanne; Schnitz, James; Shea, Shirley A.; Westbrook, Benjamin M.; Wharton, Thomas P.; Wheeler, Kirke W.; White, Dee; Keller, Robert B.; Soule, David C.; Abbott, Mary; Adrian, Lawrence; Alpern, Warren D.; Anderson, Eric; Anderson, Richard; Banister, Linda; Berg, Claire M.; Blank, Seth; Bredenberg, Carl E.; Brennan, Michael L.; Brewster, Linda R.; Burkey, David; Cirillo, Alice; Clark, Cantwell; Cleaves, Jane; Courtney, D. Mark; Cutler, Joshua; Donegal, Desmond; Fallo, Pat; Hanley, Daniel F.; Kane, Jane; Katz, Saul; Kellett, Mirle A.; Kramer, Robert S.; Lambrew, Costas T.; Larned, F. Stephen; Lutes, Chris A.; Nowicki, Edward R.; O’Meara, John R.; Osher, Harold L.; Peasley, Patricia; Prouty, Cathy; Quinn, Reed D.; Redfield, Dennis L.; Reynolds, Karen; Ryan, Thomas J.; Saunders, Jean; Schultz, Alyce A.; Seekins, Susan; Stogsdill, Russell; Sweeny, Paul W.; Tolan, Karen M.; Tooker, Nancy; Tryzelaar, Joan F.; Turcotte, Marie; Viger, Kathy; Westlund, Cynthia; White, Richard L.; Whittet, Wanda; Zografos, Carol

doi:10.1001/jama.1996.03530350023029

Cited by 608 publications

(144 citation statements)

References 19 publications

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“…With few exceptions (e.g., Westphal, Gulati, and Shortell 1997;Shortell et al 2000), most have used perceptual measures of impact or self-reported estimates of cost or clinical impact rather than objectively derived measures of clinical quality (Gilman and Lammers 1995;Shortell et al 1995b). Other multisite, comparative studies have explicitly examined the impact of hospital QI on clinical practice (Carlin, Carlson, and Nordin 1996;O'Connor et al 1996;Gordian and Ballard 1997;Goldberg et al 1998;Ferguson et al 2003). However, nearly all of these studies focused on a single clinical quality indicator (e.g., risk-adjusted mortality for coronary artery bypass surgery [CABG], adverse drug event) or single clinical practice (e.g., immunization, guideline use) rather than a broad range of measures indicative of quality at an institutional level.…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

142

106

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Objective. To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources. Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design. Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods. Moreover, as much as one-third of some hospital procedures expose patients to risks without improving their health; one-third of drugs prescribed are not indicated; and one-third of laboratory tests showing abnormal results do not get followed up by clinicians (Dubois and Brook 1988;Brook et al. 1990;Leape 1994; Institute of Medicine 2000).Many believe that quality improvement (QI) represents a promising strategy for improving hospital quality of care. QI is a systemic approach to planning and implementing continuous improvement in performance. QI emphasizes continuous examination and improvement of work processes by teams of organizational members trained in basic statistical techniques and problem solving tools and empowered to make decisions based on their analysis of the data. The systemic focus of QI complements a growing recognition in the field that the quality of the care delivered by clinicians depends substantially on the performance capability of the organizational systems in which they work. While individual clinician competence remains important, many increasingly see the capability of organizational systems to prevent errors, coordinate care among settings and practitioners, and ensure that relevant, accurate information is available when needed as critical elements in providing high quality care (Institute of Medicine 2000). Reflecting the growing emphasis on organizational systems of care, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the Peer Review Organizations of the Centers for Medicare and Medicaid have all encouraged hospitals to use QI methods.Although QI holds promise for improving quality of care, hospitals that adopt QI often struggle with its implementation (Shortell, Bennett, and Byck 1998). By implementation, we refer to the transition period, following a decision to adopt a new idea or practice, when intended users put that new idea or practice into use--for example, when clinical and nonclinical staff begin applying QI principles and practices to improve clinical care processes ( et al. 2004). In addition, the systemic nature of many quality problems implies that the effectiveness of a QI initiative may depend on its implementation across many conditions, disciplines, and departme...

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Section: Introductionmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

142

106

View full text Add to dashboard Cite

show abstract

“…Pioneered by the Northern New England Cardiovascular Disease Study Group, regional collaborative improvement programs are based upon clinical registries containing detailed information about patients' risk status, processes of care, and outcomes. 18 Hospitals and physicians receive regular and (usually) confidential feedback on their performance from their registry coordinating center-for example, risk-adjusted mortality rates for cardiac surgery. Hospital officials and physicians convene regularly to review and interpret their data, often focusing on areas of variation in practice or outcomes.…”

Section: Background On Hospital Quality Improvementmentioning

confidence: 99%

How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of Care

et al. 2011

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There is evidence that collaborations between hospitals and physicians in particular regions of the country have led to improvements in the quality of care. Even so, there have not been many of these collaborations. We review one, the Michigan regional collaborative improvement program, which was paid for by a large private insurer, has yielded improvements for a range of clinical conditions, and has reduced costs in several important areas. In general and vascular surgery alone, complications from surgery dropped almost 2.6 percent among participating Michigan hospitals-a change that translates into 2,500 fewer Michigan patients with surgical complications each year. Estimated annual savings from this one collaborative are approximately $20 million, far exceeding the cost of administering the program. Regional collaborative improvement programs should become increasingly attractive to hospitals and physicians, as well as to national policy makers, as they seek to improve health care quality and reduce costs.

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“…Local and regional databases are particularly noteworthy for their ability to draw data from physician groups and hospitals that are traditionally competitive relative to one another, but who agree to contribute data to build valid assessment of quality in cardiac care. Regional databases of note include those of the Northern New England Cardiovascular Disease Study Group (NNE) [6,7]. The New York State Department of Health has been building databases for reporting on adult cardiac surgery and percutaneous coronary interventions since the early 1990s, and subsequently added pediatric congenital cardiac surgery [8,9,10].…”

Section: Clinical Databasesmentioning

confidence: 99%

Risk Prediction and Outcome Analysis

Haan¹

2012

Current Concepts in General Thoracic Surgery

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A Regional Intervention to Improve the Hospital Mortality Associated With Coronary Artery Bypass Graft Surgery

Cited by 608 publications

References 19 publications

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Quality Improvement Implementation and Hospital Performance on Quality Indicators

How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of Care

Risk Prediction and Outcome Analysis

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