CCP pilot Medicare AMI patients fare better
Beta blockers use up from 32% to 50%
"The CCP provides some evidence that quality improvement is achievable in today's environment of cost control," said Thomas A. Marciniak, MD, of the Health Care Financing Administration in Baltimore, in a statement announcing the latest findings of his Cooperative Cardiovascular Project (CCP).1
Your facility may have been a part of that study. He and a team of investigators worked with Medicare patients who were discharged after being diagnosed with acute myocardial infarction (AMI) in Alabama, Connecticut, Iowa, and Wisconsin during several months in 1992 and 1995. That group was compared with a random sample of Medicare AMI patients in the rest of the nation. The researchers measured improvements in the quality of care through three indicators: clinical practice guidelines, length of stay, and mortality.
The pilot program showed improved quality of care in the selected groups, including a reduced number of heart attack deaths. Both short- and long-term mortality rates improved significantly, with a 10% relative reduction for all measures of mortality. The researchers report the number of patients who died of a heart attack after 30 days decreased slightly, and the number of patients who died after one year decreased from 32.3% to 29.6%.
The authors state, "Improvements noted in the CCP quality indicators are consistent and appear to be associated with an improvement in at least one important outcome - mortality. The magnitude of the changes is sufficiently reassuring that meaningful improvements were accomplished, rather than small changes made significant by large sample sizes."
Performance on all quality indicators improved significantly in the four pilot states:
· The administration of aspirin during hospitalization for patients without any complicating illnesses improved from 84% to 90%.
· The use of beta blockers at discharge in all eligible patients increased from 32% to 50%.
· The median length of hospital stay decreased from eight to six days, although the researchers acknowledge that part of that change may be due to the influences of other factors, such as evolving practice patterns or managed health care.
However, the investigators warn, "We should not be too complacent about the positive results. . . . We suspect that there may still be room for improvement even in the pilot states and that we have more lessons to learn from CCP and other sources about the optimum care of older patients diagnosed as having AMI."
Medicare has a legislative mandate for quality assurance, but the effectiveness of its quality improvement programs has been difficult to establish. The objective of the ongoing CCP, initiated in 1991, is to bring care for AMI patients closer to widely accepted practice guidelines. Team members collect data, analyze patterns of care, provide data to hospitals, and work with them to identify areas for quality improvement. The project's 10 clinical indicators relate to aspirin use and timing, reperfusion use and timing, beta blocker use, ACE inhibitor use and CCB avoidance in left ventricular systolic dysfunction, and smoking cessation.
Reference
1. Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: Results from the Cooperative Cardiovascular Project. JAMA 1998;279 1,351-1,357.
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