Improving the Quality of Care for Medicare Patients With Acute Myocardial Infarction: Results From the Cooperative Cardiovascular Project

CONTEXT.— Medicare has a legislative mandate for quality assurance, but the effectiveness of its population-based quality improvement programs has been difficult to establish. OBJECTIVE.— To improve the quality of care for Medicare patients with acute myocardial infarction. DESIGN.— Quality improvem...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 1998-05, Vol.279 (17), p.1351-1357
Main Authors: Marciniak, Thomas A, Ellerbeck, Edward F, Radford, Martha J, Kresowik, Timothy F, Gold, Jay A, Krumholz, Harlan M, Kiefe, Catarina I, Allman, Richard M, Vogel, Robert A, Jencks, Stephen F
Format: Article
Language:English
Subjects:
Alabama - epidemiology
Analysis. Health state
Biological and medical sciences
Cardiology - standards
Cardiology Service, Hospital - standards
Connecticut - epidemiology
Data Collection
Epidemiology
General aspects
Heart attacks
Hospital Mortality
Hospitals - standards
Humans
Iowa - epidemiology
Medical sciences
Medicare
Medicare - standards
Mortality
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Pilot Projects
Professional Review Organizations
Public health. Hygiene
Public health. Hygiene-occupational medicine
Quality Assurance, Health Care
Quality Indicators, Health Care
Quality standards
Statistics, Nonparametric
Survival Analysis
United States
Wisconsin - epidemiology
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Summary:CONTEXT.— Medicare has a legislative mandate for quality assurance, but the effectiveness of its population-based quality improvement programs has been difficult to establish. OBJECTIVE.— To improve the quality of care for Medicare patients with acute myocardial infarction. DESIGN.— Quality improvement project with baseline measurement, feedback, remeasurement, and comparison samples. SETTING.— All acute care hospitals in the United States. PATIENTS.— Preintervention and postintervention samples included all Medicare patients in Alabama, Connecticut, Iowa, and Wisconsin discharged with principal diagnoses of acute myocardial infarctions during 2 periods, June 1992 through December 1992 and August 1995 through November 1995. Indicator comparisons were made with a random sample of Medicare patients in the rest of the nation discharged with acute myocardial infarctions from August 1995 through November 1995. Mortality comparisons involved all Medicare patients nationwide with inpatient claims for acute myocardial infarctions during 2 periods, June 1992 through May 1993 and August 1995 through July 1996. INTERVENTION.— Data feedback by peer review organizations. MAIN OUTCOME MEASURES.— Quality indicators derived from clinical practice guidelines, length of stay, and mortality. RESULTS.— Performance on all quality indicators improved significantly in the 4 pilot states. Administration of aspirin during hospitalization in patients without contraindications improved from 84% to 90% (P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.279.17.1351