A regional collaborative effort for CQI in cardiovascular disease. Northern New England Cardiovascular Study Group.

BACKGROUND

The Northern New England Cardiovascular Disease Study Group has met at least three times a year since 1987 to improve the care of patients with cardiovascular disease. ADVANTAGES OF GROUP EFFORT: The group's collaborative nature has allowed members to have explicit discussions about medical decision making and practice and to benchmark with one another. By collaborating, members have been able to accumulate a large enough experience to examine the fine structure of adverse events, learn from them, and institute meaningful changes. IMPROVEMENT STRATEGIES: Focusing on coronary artery bypass grafting (CABG) procedures, the group has used three improvement strategies: (1) Outcomes are monitored across institutions. All members receive reports with information on their experience, their organization's experience, and the regional experience. (2) All members received training in quality improvement tools and techniques. (3) Members conduct comparative process analysis and benchmarking efforts to learn best practices for CABG surgery.

RESULTS

The average in-hospital mortality associated with CABG surgery in the region has decreased. The group determined that low output failure is the most common cause of post-CABG death across all hospitals, while other causes of death (for example, stroke, bleeding, arrhythmias) have more uneven distributions across hospitals. Individual hospitals have investigated their more unique causes of death; the group as a whole has undertaken a detailed study of more than 400 deaths to determine why patients die of low output failure and what can be done about it.

KEYS TO SUCCESS

Factors contributing to the group's success include the fact that a regionally recognized clinician spearheaded the effort, and a physician "carries the banner" at each institution; data, which are kept confidential, are analyzed and returned in a timely fashion so group members can examine their current, not just their past, practice; and there is an organized forum for data discussion.