Using clinical indicators in a quality improvement programme targeting cardiac care

Hickey, Annabel; Scott, Ian A; Denaro, Charles; Stewart, Neil I; Bennett, Cameron J; Theile, Therese

doi:10.1093/intqhc/mzh032

Cited by 35 publications

(41 citation statements)

References 27 publications

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“…Two articles reporting on the same study but providing different outcomes were abstracted for this analysis. 42,43 There were 7 disagreements among the reviewers about eligibility of the studies, leading to a value of 0.76. All disagreements were resolved by consensus.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of In-Hospital Multidimensional Interventions of Secondary Prevention After Acute Coronary Syndrome

et al. 2008

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Background-Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. Methods and Results-Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; nϭ37Ј585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk [RR], 0.77; 95% CI, 0.66 to 0.90; nϭ3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; nϭ99 deaths) among the controlled clinical trials. Only interventions including a provider-or system-level intervention suggested reduced mortality compared with patient-level-only interventions. Conclusions-The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit. (Circulation. 2008;117:3109-3117.)

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Section: Resultsmentioning

confidence: 99%

Efficacy of In-Hospital Multidimensional Interventions of Secondary Prevention After Acute Coronary Syndrome

et al. 2008

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“…Several studies showed that the use of indicators and quality programs significantly improve the quality of health care [62,63]. Monitoring indicators implies an administrative burden for physicians and should be worth the effort.…”

Section: Discussionmentioning

confidence: 99%

“…These efforts resulted in increased accessibility of hospital emergency departments and greater efficiency of acute and long-term care. Another study developed and reported clinical indicators as measures of the quality of care received by patients with acute coronary syndromes or congestive heart failure [63]. The study showed that clinical indicators can be used by clinicians to monitor practice standards and to effectuate change in system of care and clinician behavior.…”

Section: Discussionmentioning

confidence: 99%

Quality measurement at intensive care units: which indicators should we use?

Vos

Graafmans

Keesman

et al. 2007

Journal of Critical Care

134

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“…The ideal number of measures represents a balance between having too few (leading to over-emphasis on some aspects of care and neglect of others) and too many (causing confusion and administrative overload). Process-ofcare indicators which, in the main, comprise proportions of eligible patients who receive specific interventions, must be rigorously developed and tested using accepted methods, 35 based on current evidence, and rapidly responsive to changes in guidelines and professional consensus. They should incorporate standard data definitions which are recognised by relevant professional organisations.…”

Section: Principle 2 Use Established Evidence-based Performance Measmentioning

confidence: 99%

Pay for performance programs in Australia: a need for guiding principles

Scott¹

2008

Aust. Health Review

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Pay-for-performance (P4P) programs which reward clinical providers with incentive payments based on one or more measures of quality of care are now common in the United States and the United Kingdom and it is likely they will attract increasing interest in Australia. However, empirical evidence demonstrating effectiveness of such programs is limited and many existing programs have not had rigorous outcome evaluation. To maximise success, future P4P programs should incorporate the lessons and insights obtained from previous experience. Based on a review of published trials, program evaluations and position statements, the following principles that may guide future program design and implementation were synthesised: 1) formulate a rationale and a business case for P4P; 2) use established evidencebased performance measures; 3) use rigorous and verifiable methods of data collection and analysis; 4) define performance targets using absolute and relative thresholds; 5) use rewards that are sufficient, equitable and transparent; 6) address appropriateness of provider responses and avoid perverse incentives; 7) implement communication and feedback strategies; 8) use existing organisational structures to implement P4P programs; 9) attribute credit for performance to participants in ways that foster population-based perspectives; and 10) invest in outcomes and health service research. Recommendations flowing from these principles relevant to Australian

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Using clinical indicators in a quality improvement programme targeting cardiac care

Abstract: Use of clinical indicators succeeded in supporting clinicians to monitor practice standards and to realize change in systems of care and clinician behaviour.

Cited by 35 publications

References 27 publications

Efficacy of In-Hospital Multidimensional Interventions of Secondary Prevention After Acute Coronary Syndrome

Efficacy of In-Hospital Multidimensional Interventions of Secondary Prevention After Acute Coronary Syndrome

Quality measurement at intensive care units: which indicators should we use?

Pay for performance programs in Australia: a need for guiding principles

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