Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative

Abstract

Objective/background: This report describes the first round of results for Phase II of the Alabama CABG Project, a regional quality improvement initiative.

Methods: Charts submitted by all hospitals in Alabama performing CABG (ICD-9 codes 36.10-36.20) were reviewed by a Clinical Data Abstraction Center (CDAC) (preintervention 1999-2000; postintervention 2000-2001). Variables that described quality in Phase I were abstracted for Phase II and data describing the new variables of beta-blocker use and lipid management were collected. Data samples collected onsite by participating hospitals were used for rapid cycle improvement in Phase II.

Results: CDAC data (n = 1927 cases in 1999; n = 2001 cases in 2000) showed that improvements from Phase I in aspirin prescription, internal mammary artery use, and duration of intubation persisted in Phase II. During Phase II, use of beta-blockers before, during, or after CABG increased from 65% to 76% of patients (P < 0.05). Appropriate lipid management, an aggregate variable, occurred in 91% of patients before and 91% after the educational intervention. However, there were improvements in 3 of 5 subcategories for lipid management (documenting a lipid disorder [52%-57%], initiating drug therapy [45%-53%], and dietary counseling [74%-91%]; P < 0.05).

Conclusions: In Phase II, this statewide process-oriented quality improvement program added two new measures of quality. Achievements of quality improvement from Phase I persisted in Phase II, and improvements were seen in the new variables of lipid management and perioperative use of beta-blockers.

FIGURE 1. Prevalence of internal mammary artery utilization in the year 2000 CDAC sample is shown. Letters on the x-axis are anonymous indicators for individual Alabama hospitals.

FIGURE 2. Prevalence of aspirin prescription at hospital discharge in the year 2000 CDAC sample is shown. Letters on the x-axis are anonymous indicators for individual Alabama hosptials.

FIGURE 3. Prevalence of β-blocker use in the peri-operative interval for the year 2000 CDAC sample is shown. Letters on the x-axis are anonymous indicators for individual Alabama hospitals.

FIGURE 4. Prevalence of appropriate lipid management in the year 2000 CDAC sample is shown. Letters on the x-axis are anonymous indicators for individual Alabama hospitals.

FIGURE 5. The rate of readmission to any hospital within Alabama within 30 days following discharge post-CABG surgery is illustrated for the individual hospitals participating in the study.