A Statewide Collaborative Initiative to Improve the Quality of Care for Patients With Acute Myocardial Infarction and Heart Failure

Abstract

Background-To enhance quality improvement, we created a unique statewide collaboration among 3 organizations: the Virginia Health Quality Center (Virginia's Medicare Quality Improvement Organization), the American College of Cardiology, and the American Heart Association. The goal was to improve discharge measures for acute myocardial infarction and heart failure. Methods and Results-In 2004, 29 hospitals participated in the collaborative initiative. Using Medicare data submitted from 2004 through the second quarter of 2006, we analyzed adherence to individual discharge measures and all-or-none appropriate care measures for acute myocardial infarction, heart failure, and both. To control for differences in hospital characteristics, we were able to match 21 of the participating hospitals with 21 similar nonparticipating hospitals. In this paired analysis, the total appropriate care measure increased from 61% to 77% in participating hospitals compared with an increase from 51% to 60% in nonparticipating hospitals (PϽ0.0001). A generalized linear mixed model examining the full data set at the patient level failed to show a clear advantage among participating hospitals. Participating hospitals had higher baseline rates for most quality measures, suggesting a possible effect of a prior collaborative. Further analysis of only hospitals that participated in a prior collaborative showed that participants in the current collaborative initiative had higher rates of improvement for 7 of 10 quality measures and appropriate care measures for heart failure, acute myocardial infarction, or both (all PϽ0.05). Conclusions-We report a unique collaboration of a Medicare Quality Improvement Organization and 2 national organizations to address quality of care for acute myocardial infarction and heart failure. A composite measure of quality (the total appropriate care measure) improved more in the participating hospitals during the timeframe of the intervention, although the greater improvement in this and other measures in the participating hospitals appeared to be dependent on participation in a prior collaborative initiative.

Geographic Disparities in Heart Failure Hospitalization Rates Among Medicare Beneficiaries

“…Furthermore, cardiac rehabilitation has been shown to improve outcomes for cardiac patients, thereby contributing to the prevention of subsequent HF (15). Therefore, clinicians, medical care organizations, health policy analysts, state health department officials, and other public health professionals can use data provided in these maps of HF hospitalization rates to guide their efforts at reducing the geographic disparities in HF around the country (16). The data presented here are subject to several limitations given that Medicare data are collected for administrative purposes rather than explicitly for epidemiological studies.…”

Structure and process measures of quality of care in adult congenital heart disease patients: A pan-Canadian study

“…Similar to other guideline sets in cardiovascular medicine, these have not only focused on lesion specific strategies and methods to optimize delivery of care, but have also specified how care of ACHD patients should be regionalized. Throughout the cardiology field there has been an increasing emphasis to quality measures aimed at improving quality of care [11,12]. Although various definitions exist, quality of care can be defined as the degree to which health services for individual and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge [13,14].…”

Patient experience within the adult congenital heart disease outreach network: a questionnaire-based study

“…Direct feedback from patients is considered the best way to measure the quality of their experiences [26]. In Cardiology there has been a growing emphasis in quality measures aimed at improving quality of care [27,28]. Although there are increasing attempts to standardise metrics of care and outcomes in congenital heart disease [29,30], there are scarce data on the ACHD population.…”