Do Local Opinion Leaders Augment Hospital Quality Improvement Efforts?: A Randomized Trial to Promote Adherence to Unstable Angina Guidelines

• Published in: Medical care 2003-03, Vol.41 (3), p.420-431
• Main Authors: Berner, Eta S., Baker, C. Suzanne, Funkhouser, Ellen, Heudebert, Gustavo R., Allison, Jeroan J., Fargason, Crayton A., Li, Qing, Person, Sharina D., Kiefe, Catarina I.
• Format: Article
• Language: English
• Subjects: Aged; Alabama; Algorithms; Angina, Unstable - diagnostic imaging; Angina, Unstable - drug therapy; Angina, Unstable - therapy; Attitude of Health Personnel; Guideline Adherence - statistics & numerical data; Health care quality; Health Services Research; Heparin; Hospitals; Hospitals - standards; Humans; Leadership; Medical Audit; Medical practice; Medical Staff, Hospital - standards; Medicare; Medicare Part A; Medications; Models, Organizational; Opinion leaders; Peer Review, Health Care; Physicians; Practice Guidelines as Topic; Quality Indicators, Health Care; Radiography; Teaching hospitals; Total Quality Management - organization & administration; Unstable angina
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/01.MLR.0000052977.24246.38

Background. The influence of an opinion leader intervention on adherence to Unstable Angina (UA) guidelines compared with a traditional quality improvement model was investigated. Research Design. A group-randomized controlled trial with 2210 patients from 21 hospitals was designed. There were three intervention arms: (1) no intervention (NI); (2) a traditional Health Care Quality Improvement Program (HCQIP); and (3) a physician opinion leader in addition to the HCQIP model (OL). Quality indicators included: electrocardiogram within 20 minutes, antiplatelet therapy within 24 hours and at discharge, and heparin and β-blockers during hospitalization. Hospitals could determine the specific indicators they wished to target. Potential cases of UA were identified from Medicare claims data. UA confirmation was determined by a clinical algorithm based on data abstracted from medical records. Data analyses included both hospital level analysis (analysis of variance) and patient level analysis (generalized linear models). Results. The only statistically significant postintervention difference in percentage compliant was greater improvement for the OL group in the use of antiplatelet therapy at 24 hours in both hospital level (P = 0.01) and patient level analyses (P