| Titre : | Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery A randomized controlled trial. (2003) |
| Auteurs : | Tbruce-Jr FERGUSON ; Meghan-L CAREY ; Laura-P COOMBS ; Elizabeth-R DELONG ; Mary-C EIKEN ; Frederick-L GROVER ; Eric-D PETERSON ; Duke Clinical Research Institute. Duke University. Durham. NC. USA ; Society of Thoracic Surgeons. Chicago. IL. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 290, n° 1, 2003) |
| Pagination : | 49-56 |
| Langues: | Anglais |
| Mots-clés : | Greffon ; Chimiothérapie ; Phase préopératoire ; Politique santé ; Essai thérapeutique ; Randomisation ; Homme ; Chirurgie ; Chirurgie cardiovasculaire ; Appareil circulatoire [pathologie] ; Cardiopathie coronaire |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 99bR0xdM. Diffusion soumise à autorisation]. Context A rigorous evaluation of continuous quality improvement (CQI) in medical practice has not been carried out on a national scale. Objective To test whether low-intensity CQI interventions can be used to speed the national adoption of 2 coronary artery bypass graft (CABG) surgery process-of-care measures : preoperative bêta-blockade therapy and internal mammary artery (IMA) grafting in patients 75 years or older. Design, Setting, and Participants Three hundred fifty-nine academic and non-academic hospitals (treating 267917 patients using CABG surgery) participating in the Society of Thoracic Surgeons National Cardiac Database between January 2000 and July 2002 were randomized to a control arm or to 1 of 2 groups that used CQI interventions designed to increase use of the process-of-care measures. Intervention Each intervention group received measure-specific information, including a call to action to a physician leader ; educational products ; and periodic longitudinal, nationally benchmarked, site-specific feedback. Main Outcome Measure Differential incorporation of the targeted care processes into practice at the intervention sites vs the control sites, assessed by measuring preintervention (January-December 2000)/postintervention (January 2001-July 2002) site differences and by using a hierarchical patient-level analysis. Results From January 2000 to July 2002, use of both process measures increased nationally (bêta-blockade, 60.0% - 65.6% ; IMA grafting, 76.2% - 82.8%). Use of bêta-blockade increased significantly more at bêta-blockade intervention sites (7.3% [SD, 12.8% ]) vs control sites (3.6% [SD, 11.5% ]) in the preintervention/postintervention (P=04) and hierarchical analyses (P<. 001). Use of IMA grafting also tended to increase at IMA intervention sites (8.7% [SD, 17.5% ]) vs control sites (5.4% [SD, 15.8% ]) (P=20 and P=11 for preintervention/postintervention and hierarchical analyses, respectively). Both interventions tended to have more impact at lower-volume CABG sites (for interaction : P=04 for bêta-blockade ; P=02 for IMA grafting). Conclusions A multifaceted, physician-led, low-intensity CQI effort can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. |
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