What question did this study set out to answer?

To evaluate whether confidential hospital performance feedback combined with multimodal improvement interventions and peer collaboration enhances care quality and outcomes in coronary artery bypass grafting (CABG) surgery.

June 20, 2001JAMA

Alabama Coronary Artery Bypass Grafting Project

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Why the study?

Does confidential hospital-specific performance feedback and shared experience improve process measures and clinical outcomes in Medicare patients undergoing CABG surgery?

Population

12,756 Medicare patients discharged after coronary artery bypass grafting surgery, comprising patients in…

Comparison

Confidential hospital-specific performance… vs Standard care in a comparison state and a…

Design

Cohort

Follow-up

In-hospital and at discharge

Authors

WHWilliam L. HolmanUniversity of Alabama at Birmingham RARichard M. AllmanHeart Failure / Cardiomyopathy MSMonique SansomUniversity of Alabama at Birmingham

Discussion

Member takes

Implication

Regional QI feedback improved CABG process measures without significantly greater mortality reduction than national trends; leaves open whether such interventions affect clinical outcomes.

Key Points

To evaluate whether confidential hospital performance feedback combined with multimodal improvement interventions and peer collaboration enhances care quality and outcomes in coronary artery bypass grafting (CABG) surgery.
Assessed medical records across all 20 Alabama hospitals performing CABG surgery at baseline (July 1995–June 1996) and follow-up (July–December 1998).
Included Medicare patients undergoing CABG in Alabama (n = 5,784), an external comparison state (n = 3,214), and a national sample (n = 3,758).
Delivered confidential hospital-specific performance feedback alongside multimodal quality improvement support and shared peer experiences.
Early extubation within 6 hours increased from 9% to 41% in Alabama versus 40% to 39% in the comparison state and 12% to 25% nationally (P < .001).
Internal mammary artery use increased from 73% to 84% in Alabama versus 48% to 55% in the comparison state (P = .001) and 74% to 81% nationally (P = .02), with discharge aspirin use rising only in Alabama (88% to 92%, P < .001).
Risk-adjusted in-hospital mortality decreased from 4.9% to 2.9% in Alabama, which was not statistically significantly different from national trends (OR 0.76; 95% CI, 0.54–1.07).

Structured PICO

Does confidential hospital-specific performance feedback and shared experience improve process measures and clinical outcomes in Medicare patients undergoing CABG surgery?

Population

12,756 Medicare patients discharged after coronary artery bypass grafting (CABG) surgery, comprising patients in Alabama (n=5,784), a comparison state (n=3,214), and a national sample (n=3,758).

Intervention

Confidential hospital-specific performance feedback and assistance with multimodal improvement interventions, including the option to share relevant experience with peers.

Comparator

Standard care in a comparison state and a national sample without the specific regional quality improvement intervention.

Outcome

Duration of intubation, reintubation rate, aspirin therapy at discharge, use of the internal mammary artery (IMA), hospital readmission rate, and risk-adjusted in-hospital mortality.

A regional quality improvement initiative using performance feedback significantly improved surgical process measures for CABG but did not significantly reduce risk-adjusted mortality compared to national trends.

Cite This Study

Holman et al. (2001) studied this question.

synapsesocial.com/papers/6a7ad3d4bdf697b3de02cb90 https://doi.org/10.1001/jama.285.23.3003

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Implication

Regional QI feedback improved CABG process measures without significantly greater mortality reduction than national trends; leaves open whether such interventions affect clinical outcomes.

Alabama Coronary Artery Bypass Grafting Project

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Alabama Coronary Artery Bypass Grafting Project

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider