Résumé :
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[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<. use of ima grafting also tended to increase at intervention sites vs control and p="11" for preintervention hierarchical analyses respectively both interventions have more impact lower-volume cabg interaction : b conclusions a multifaceted physician-led low-intensity cqi effort can improve the adoption care processes into national practice within context medical specialty society infrastructure.>
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