Division of Cardiovascular and Thoracic Surgery, Sparrow Hospital, Lansing, Michigan, USA.
Ann Thorac Surg. 2010 Oct;90(4):1158-64; discussion 1164. doi: 10.1016/j.athoracsur.2010.05.047.
The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative is a voluntary, surgeon-directed quality initiative involving all cardiac surgery programs in Michigan. Understanding that internal mammary artery (IMA) use during coronary artery bypass grafting is an important process measure associated with improved outcomes, this analysis reviews our methodology to understand IMA use and increase appropriate IMA use statewide.
Adult cardiac Society of Thoracic Surgeons data were collected at each Michigan site and submitted quarterly to the Duke Clinical Research Institute and the MSTCVS. Seven cardiac surgery programs with IMA use less than 90% in isolated coronary artery bypass grafting were identified as low IMA users. An improvement plan was adopted at the state level and included quarterly monitoring of IMA use, documenting the rationale for IMA exclusion, evidence-based lectures, feedback letters to sites, and physician-led site visits if no improvement was noted.
From 2005 through 2008, 29,114 patients underwent coronary artery bypass grafting in Michigan. Internal mammary artery utilization varied widely at the beginning of this investigation, ranging from 66.2% to 98.4%. Seven Michigan programs were identified as low IMA users. Using the MSTCVS Quality Collaborative's process-improvement plan, collectively the seven low IMA users increased IMA grafting from 82.0% to 92.7% (p < 0.0001). Michigan IMA use increased from 91.9% to 95.8% (p < 0.0001) and is now higher than The Society of Thoracic Surgeons' average.
The MSTCVS Quality Collaborative identified programs with low IMA use and created an environment to enhance IMA utilization during coronary artery bypass grafting, a significant operative process. These findings illustrate the value of a statewide surgeon-directed quality initiative in improving processes and outcomes for patients.
密歇根胸心血管外科医师学会（MSTCVS）质量协作组织是一项自愿性、由外科医生主导的质量倡议，涉及密歇根州所有心脏手术项目。我们了解到，在冠状动脉旁路移植术中使用内乳动脉（IMA）是与改善结果相关的重要手术过程指标，因此，本分析旨在回顾我们的方法，以了解 IMA 的使用情况并在全州范围内增加适当的 IMA 使用。
从每个密歇根州的地点收集成人心脏胸外科医师学会数据，并按季度提交给杜克临床研究所以及 MSTCVS。确定了 7 个 IMA 使用率低于 90%的单纯冠状动脉旁路移植术的低 IMA 使用心脏手术项目为低 IMA 用户。在州一级采用了改进计划，包括按季度监测 IMA 的使用情况、记录 IMA 排除的理由、进行基于证据的讲座、向各地点发送反馈信，如果没有改进则由医生领导进行现场访问。
2005 年至 2008 年，密歇根州有 29114 名患者接受了冠状动脉旁路移植术。在本研究开始时，IMA 的利用率差异很大，范围从 66.2%到 98.4%。确定了 7 个密歇根州的项目为低 IMA 用户。使用 MSTCVS 质量协作组织的流程改进计划，这 7 个低 IMA 用户的 IMA 移植物总数从 82.0%增加到 92.7%（p < 0.0001）。密歇根州的 IMA 使用率从 91.9%增加到 95.8%（p < 0.0001），现在高于胸外科医师学会的平均水平。
MSTCVS 质量协作组织确定了低 IMA 使用的项目，并创建了一个环境，以在冠状动脉旁路移植术中增强 IMA 的使用，这是一个重要的手术过程。这些发现说明了全州范围内由外科医生主导的质量倡议在改善患者流程和结果方面的价值。
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