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Randomized Controlled Trial
. 2011 Jan 4;123(1):39-45.
doi: 10.1161/CIRCULATIONAHA.110.981068. Epub 2010 Dec 20.

Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice

Judson B Williams  1 , Elizabeth R Delong, Eric D Peterson, Rachel S Dokholyan, Fang-Shu Ou, T Bruce Ferguson Jr; Society of Thoracic Surgeons and the National Cardiac Database
Affiliations
Randomized Controlled Trial

Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice

Judson B Williams et al. Circulation. .

Abstract

Background: Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting.

Methods and results: A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications at intervention versus control sites, assessed by measuring preintervention and postintervention site differences. Prerandomization treatment patterns and baseline data were similar in the control (n=234) and treatment (n=224) groups. Individual medication use and composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 secondary prevention medications.

Conclusions: Provider-led, low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement.

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Figures

Figure 1
Figure 1
Flow of sites through trial
Figure 2
Figure 2
Histograms demonstrating the wide variance in both A, baseline hospital All vs. Not All performance scores (assigned a value of 1 if a patient had every medication for which they were eligible and a value of 0 if patients had less than every medication) and B, overall hospital adherence scores (number of therapies given divided by the number of eligible opportunities).
Figure 3
Figure 3
Plot for change in adherence to recommended secondary prevention (SP) medications. A, change in adherence to All vs. Not All performance scores recommended SP medications. B, change in overall hospital adherence scores for recommended secondary prevention medications.
See this image and copyright information in PMC

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References

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