Quality improvement initiative and its impact on the management of patients with acute myocardial infarction.

BACKGROUND

Wide variation exists in acute myocardial infarction (AMI) management, leading to differences in outcomes.

OBJECTIVE

To assess the impact of the quality improvement initiative on appropriate management of AMI.

DESIGN

Prospective patient identification, retrospective medical record review.

PATIENTS

All patients with AMI discharged alive (N = 497) from our institution between April 1, 1995, and February 28, 1997.

MAIN OUTCOME MEASURE

The effect of quality improvements directed at the patient, nurse, and physician on the adherence to key quality indicators.

RESULTS

The quality improvement initiative correlated with more frequent use of reperfusion therapy (98%), and with aspirin use in the emergency department (95%), in ideal eligible patients. Similarly, adherence to discharge quality indicators, including use of aspirin (97%), beta-blockers (94%), angiotensin-converting enzyme inhibitors (90%), and lipid-lowering agents (67%); avoidance of calcium channel blockers (93%); a low-fat diet (96%); smoking cessation counseling (94%); and outpatient rehabilitation referral (70%) was higher, including in the very old (those aged >/=80 years) and in women. The use of a patient education tool was associated with a higher adherence to most quality indicators compared with patients in whom this was not used: discharge aspirin (99% vs 96%; P =.02), beta-blocker (98% vs 91%; P =.002), angiotensin-converting enzyme inhibitor (95% vs 86%; P =.01), and lipid-lowering agent (71% vs 62%; P =.04) use; outpatient rehabilitation (82% vs 63%; P=.001); and documentation of smoking cessation counseling (98% vs 87%; P =. 001).

CONCLUSIONS

Implementation of a quality improvement program was associated with a high adherence to quality-of-care indicators for AMI. Patient-directed feedback before discharge improved adherence to key indicators for AMI beyond that achieved with tools only directed at caregivers.